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.