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

• SME –

Pricing, Market Access & Revenue Management

Act as Techno-functional SME

for:

Medicaid Rebates &

Medicaid Claim Level detail (CLD) (primary)

Government Pricing (secondary)

• 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

• 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

• Testing,

Validation & Deployment

Lead System Integration

Testing (SIT) and User Acceptance Testing (UAT)

• Stakeholder

Collaboration & Leadership

• Act as a bridge between
• business stakeholders and IT teams
• Collaborate with
• cross-functional teams:

Market Access

Finance

IT / Engineering

Facilitate workshops to define business

use cases and future-state processes

• 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.