Job Description – Senior Techno-Functional SME (Medicaid Applications)
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:
- 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.
Never miss an opportunity! Create an alert based on the job you applied for.