Techno Functional SME - Medicaid
Role
Overview
We are looking for a highly experienced
Senior Techno-Functional Subject Matter Expert (SME) with 12+ years of
experience in Medicaid systems, Medicaid claims processing and regulatory
compliance. Model N Flex/ PbyN experience
remains highly desirable along with SQL, PL/SQL and Cognos expertise.
This position plays a critical role in bridging
business needs and technology, driving product implementations, integrations,
and process transformations using platforms such as Model N , Revitas and
modern cloud-based solutions.
Key Responsibilities
1.
Business Analysis & Strategic Solutioning
- Lead end-to-end requirement
gathering and stakeholder workshops across Commercial contracting and
revenue management.
- Translate business needs into:
- Functional Requirements
specification(FRS)
- Technical Design specification
(TDS)
- Perform gap analysis and
recommend optimized solutions aligned with business goals
- Partner with leadership to
align strategic initiatives with IT transformation roadmap
2. SME –
Pricing, Market Access & Revenue Management
- Act as Techno-functional SME
for:
- Medicaid Rebates &
Medicaid Claim Level detail (CLD) (primary)
- Government Pricing (secondary)
3. Product
Implementation & Integration
- Drive implementation and
configuration of:
- Model N Flex (primary)
- ModelN PbYN
- Lead integration design across:
- ERP systems
- Data warehouses
- Upstream/downstream pricing
systems
- Ensure scalable, cloud-enabled
architecture for Medicaid rebate solutions
4. Data
Analysis & Business Insights
- Perform data analysis and
validation using SQL / PL-SQL / Informatica
- Conduct financial impact
assessments for pricing and contracting changes
- Identify trends, risks, and revenue
leakage opportunities
- Support data-driven
decision-making with actionable insights
5. Testing,
Validation & Deployment
- Lead System Integration
Testing (SIT) and User Acceptance Testing (UAT)
6. Stakeholder
Collaboration & Leadership
- Act as a bridge between
business stakeholders and IT teams
- Collaborate with
cross-functional teams:
- Market Access
- Finance
- Compliance
- IT / Engineering
- Facilitate workshops to define business
use cases and future-state processes
7. Innovation
& Transformation
- Drive adoption of emerging
technologies such as:
- Cloud-based platforms
- Identify opportunities for:
- Operational efficiency
- Cost optimization
- Process automation
Required
Skills & Experience
✅ Domain Expertise
- Deep expertise in:
- Medicaid rebates and CLD
- Government Pricing and
Compliance
- Pricing & Market Access
- Strong understanding of pharmaceutical
commercial and regulatory landscapes
✅ Technical Skills
- Hands-on experience with:
- Model N (mandatory)
- Revitas
- Strong data skills:
- SQL / PL-SQL
- Informatica / ETL tools
- UNIX
- Experience working with Cloud
platforms (AWS/Azure)
✅ Functional Capabilities
- Requirement gathering and
stakeholder management
- Gap analysis and solution
design
- System configuration and
implementation
- Testing (SIT, UAT) and
validation
- Strong documentation and
process modeling skills
Why Join Us?
You will join a mission-critical team where
your work directly impacts profit margins and ensures compliance in a rapidly
evolving regulatory environment. You'll have the autonomy to drive innovation
and the tools to make a measurable difference in protecting the organization’s
revenue integrity.