Techno Functional SME - Medicaid

SRM Technologies•North America, NJ

20h

About The Position

We are seeking a highly experienced Senior Techno-Functional Subject Matter Expert with 12+ years of experience in Medicaid systems, claims processing, and regulatory compliance. The role bridges business needs and technology to drive product implementations, integrations, and process transformations using platforms such as Model N, Revitas, and cloud-based solutions. Model N Flex/PbyN experience is highly desirable, along with SQL, PL/SQL, and Cognos expertise. The SME will focus primarily on Medicaid rebates and Medicaid Claim Level Detail (CLD), with Government Pricing as a secondary area. The position supports compliant, scalable Medicaid rebate solutions and contributes to pricing, market access, revenue management, and broader IT transformation initiatives. The work directly affects profit margins and revenue integrity in a changing regulatory environment.

Requirements

12+ years of experience in Medicaid systems, Medicaid claims processing, and regulatory compliance.
Deep expertise in Medicaid rebates and Claim Level Detail (CLD).
Strong understanding of Government Pricing and compliance.
Expertise in pricing and market access.
Strong understanding of pharmaceutical commercial and regulatory landscapes.
Hands-on experience with Model N; listed as mandatory.
Strong data skills in SQL and PL/SQL.
Experience with Informatica or ETL tools.
UNIX experience.
Experience working with cloud platforms such as AWS or Azure.
Ability to gather requirements and manage stakeholders.
Experience with gap analysis, solution design, system configuration, and implementation.
Experience with SIT, UAT, and validation.
Strong documentation and process modeling skills.

Nice To Haves

Model N Flex/PbyN experience.
Revitas experience.
Cognos expertise.

Responsibilities

Lead end-to-end requirements gathering and stakeholder workshops across commercial contracting and revenue management.
Translate business needs into Functional Requirements Specifications (FRS) and Technical Design Specifications (TDS).
Perform gap analysis and recommend optimized solutions aligned with business goals.
Partner with leadership to align strategic initiatives with the IT transformation roadmap.
Serve as a techno-functional SME for Medicaid rebates and Medicaid Claim Level Detail (primary) and Government Pricing (secondary).
Drive implementation and configuration of Model N Flex and Model N PbyN.
Lead integration design across ERP systems, data warehouses, and upstream and downstream pricing systems.
Ensure scalable, cloud-enabled architecture for Medicaid rebate solutions.
Analyze and validate data using SQL, PL/SQL, and Informatica.
Conduct financial impact assessments for pricing and contracting changes.
Identify trends, risks, and revenue leakage opportunities, and support data-driven decision-making with actionable insights.
Lead System Integration Testing (SIT) and User Acceptance Testing (UAT).
Bridge business stakeholders and IT teams, collaborating with Market Access, Finance, Compliance, and IT/Engineering.
Facilitate workshops to define business use cases and future-state processes.
Drive adoption of emerging technologies such as cloud-based platforms.
Identify opportunities for operational efficiency, cost optimization, and process automation.