Note: The job is a remote job and is open to candidates in USA. GeneDx delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The Manager, Medicaid Policy & Operations serves as the internal subject matter expert on Medicaid reimbursement requirements, monitoring state policies and translating them into actionable insights to support market access strategy and reimbursement readiness.
Responsibilities
- Monitor state Medicaid fee schedules, rate updates, public meeting calendars, and program requirements across U.S. Medicaid programs to identify changes that may affect reimbursement and operational execution, including researching and compiling reimbursement requirements needed to support implementation when new coverage becomes effective
- Serve as an internal subject matter expert on state-specific Medicaid reimbursement requirements, including EPSDT processes, documentation expectations, and prior authorization and claim submission considerations
- Partner closely with Medicaid Policy Directors in Market Access on submission of policy change requests and issue escalation within the Medicaid agencies, helping prepare materials and uncover state-specific processes
- Support Regional Market Access Directors by synthesizing data, research, and supporting resources to inform targeted reimbursement and contracting strategies for high-priority out-of-network payors
- Maintain centralized tracking of Medicaid reimbursement issues, payment variances, policy questions, and escalation needs, including status updates, owners, and next steps
- Translate state Medicaid policy and reimbursement requirements into clear, actionable guidance for the Revenue Cycle Team to support accurate and consistent execution
- Analyze claims data, denial trends, payment variances, and prior authorization outcomes to identify root causes, surface reimbursement insights, and recommend data-informed process improvements for Market Access and Revenue Cycle partners
- Develop and maintain state- and payor-specific standard operating procedures, reference materials, and workflows to improve consistency and reduce rework
- Synthesize reimbursement insights and operational trends into recommendations for Market Access leadership to inform prioritization, escalation, and strategic decision-making
Skills
- 4–7+ years of experience in Medicaid policy or Medicaid operations
- Experience analyzing claims data and identifying drivers of denials or reimbursement variability
- Ability to use claims data, research, and external outreach (e.g., Medicaid agencies) to identify root causes and develop standardized processes
- Strong analytical, organizational, and communication skills
- Strong proficiency in Excel and comfort working with claims-level datasets to identify trends, summarize findings, and support data-driven decision-making
- Bachelor's degree in healthcare, public policy, business, or related field
- Experience working within a Medicaid agency, managed care organization
- Hands-on experience with EPSDT programs
Benefits
- This is a fully remote position.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
- We provide competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate, helping employees thrive both professionally and personally.
Company Overview