Manager, Medicaid Policy & Operations

Job 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
• Closely partner 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

Requirements

• Bachelor’s degree in healthcare, public policy, business, or related field preferred
• 4–7+ years of experience in Medicaid policy or Medicaid operations
• Experience working within a Medicaid agency, managed care organization strongly preferred
• Hands-on experience with EPSDT programs strongly preferred
• 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

Qualifications

• No formal education required
• No specific experience required
• No specific skills required

Skills

• Hands-on Medicaid experience
• Exposure to state agency operations
• Experience with EPSDT programs
• Experience analyzing claims data
• Ability to use claims data, research, and external outreach to identify root causes and develop standardized processes
• Strong analytical, organizational, and communication skills
• Strong proficiency in Excel

Benefits

GeneDx offers a competitive compensation and benefits package that reflects local market practices and legal requirements in each country where we operate. We also provide a supportive work environment with a focus on personal and professional growth.

Pay

$96,000—$118,000 USD

Schedule

This is a fully remote position. The employee will work from a home office or other suitable remote location with reliable high-speed internet access. Work is performed in a climate-controlled environment using standard office equipment including computer, phone, and video conferencing tools. Your standard work schedule and hours will be established in collaboration with your leader and may be adjusted to align with evolving business needs.