Manager, Medicaid Policy & Operations
Develop Medicaid policy insights
The Manager, Medicaid Policy & Operations monitors state Medicaid policies and translates them into actionable insights to support market access strategy. This role serves as the internal subject matter expert on Medicaid reimbursement requirements across the United States.
Why This Role?
Be part of a company transforming healthcare through genomic and large-scale clinical information
Key Responsibilities
- Monitor state Medicaid administrative policies
- Translate policies into actionable insights
- Support market access strategy
Requirements
- Medicaid reimbursement knowledge
- Market access strategy understanding
- Analytical skills
Required Skills
Indonesia Context
- Working Hours Overlap:
- Flexible — work your own hours
View Original Description from Greenhouse BoardsShow more
Original description from Greenhouse Boards
<p><span data-contrast="none"><span data-ccp-parastyle="paragraph" data-ccp-parastyle-defn="{"ObjectId":"aaed607e-c2a3-5841-9fb4-41037bfa0faf|1","ClassId":1073872969,"Properties":[201342446,"1",201342447,"5",201342448,"1",201342449,"1",469777841,"Times New Roman",469777842,"Times New Roman",469777843,"Times New Roman",469777844,"Times New Roman",201341986,"1",469769226,"Times New Roman",268442635,"24",469775450,"paragraph",201340122,"2",134233614,"true",469778129,"paragraph",335572020,"1",335559740,"240",201341983,"0",134233118,"true",134233117,"true",469778324,"Normal"]}">GeneDx</span><span data-ccp-parastyle="paragraph"> (Nasdaq: WGS) delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable precision medicine as the standard of care. </span><span data-ccp-parastyle="paragraph">GeneDx</span><span data-ccp-parastyle="paragraph"> is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world’s largest, rare disease data sets. For more information, please visit </span></span><a href="http://www.genedx.com/"><span data-contrast="none"><span data-ccp-charstyle="Hyperlink">www.genedx.com</span></span></a><span data-contrast="none"><span data-ccp-parastyle="paragraph">.</span></span><span data-ccp-props="{"134233117":true,"134233118":true,"201341983":0,"335559739":0,"335559740":240}"> </span></p> <p><strong><span data-contrast="auto">Summary </span></strong><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <p><span data-contrast="auto">The Manager, Medicaid Policy & Operations is part of the Market Access team and serves as the internal subject matter expert on Medicaid reimbursement requirements across the United States. This role monitors state Medicaid administrative policies, fee schedules, and program requirements and translates them into actionable insights that support market access strategy and reimbursement readiness for medically necessary testing.</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <p><span data-contrast="auto">The Manager works closely with Medicaid Policy Directors in Market Access, who own GeneDx’s relationships with Medicaid agency leadership, and partners with the Revenue Cycle Team to help ensure state-specific reimbursement requirements are clearly understood and reflected in internal guidance and processes. Medicaid is a critical coverage pathway for children with rare diseases and complex medical needs, and this role supports GeneDx’s mission to ensure they have access to a diagnosis by helping operationalize Medicaid reimbursement requirements across state programs.</span> <span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <p><span data-contrast="auto">The ideal candidate brings hands-on Medicaid experience, including exposure to state agency operations and Medicaid EPSDT or Special Needs programs. They are comfortable working with claims data, Excel, and other data tools to identify patterns, surface reimbursement insights, and translate findings into actionable recommendations. They are resourceful in uncovering state-specific reimbursement requirements and denial issues and can use claims data, research, and external outreach to identify root causes of payment issues, clarify reimbursement requirements, and inform standardized approaches.</span><span data-ccp-props="{}"> </span></p> <p><strong><span data-contrast="auto">Job Responsibilities</span></strong> <span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">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</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1"><span data-contrast="auto">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</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1"><span data-contrast="auto">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</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">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</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="5" data-aria-level="1"><span data-contrast="auto">Maintain centralized tracking of Medicaid reimbursement issues, payment variances, policy questions, and escalation needs, including status updates, owners, and next steps</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="6" data-aria-level="1"><span data-contrast="auto">Translate state Medicaid policy and reimbursement requirements into clear, actionable guidance for the Revenue Cycle Team to support accurate and consistent execution</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="7" data-aria-level="1"><span data-contrast="auto">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</span><span data-ccp-props="{"335559685":1080}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="8" data-aria-level="1"><span data-contrast="auto">Develop and maintain state- and payor-specific standard operating procedures, reference materials, and workflows to improve consistency and reduce rework</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="14" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="9" data-aria-level="1"><span data-contrast="auto">Synthesize reimbursement insights and operational trends into recommendations for Market Access leadership to inform prioritization, escalation, and strategic decision-making</span><span data-ccp-props="{"335559685":1080,"335559991":360}"> </span></li> </ul> <p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span><strong><span data-contrast="auto">People Manager</span></strong> <span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <p><span data-contrast="auto">No</span> <span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <p><strong><span data-contrast="auto">Education, Experience, and Skills</span></strong><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Bachelor’s degree in healthcare, public policy, business, or related field preferred</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1"><span data-contrast="auto">4–7+ years of experience in Medicaid policy or Medicaid operations</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1"><span data-contrast="auto">Experience working within a Medicaid agency, managed care organization strongly preferred</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Hands-on experience with EPSDT programs strongly preferred</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="5" data-aria-level="1"><span data-contrast="auto">Experience analyzing claims data and identifying drivers of denials or reimbursement variability </span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="6" data-aria-level="1"><span data-contrast="auto">Ability to use claims data, research, and external outreach (e.g., Medicaid agencies) to identify root causes and develop standardized processes</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="7" data-aria-level="1"><span data-contrast="auto">Strong analytical, organizational, and communication skills</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="8" data-aria-level="1"><span data-contrast="auto">Strong proficiency in Excel and comfort working with claims-level datasets to identify trends, summarize findings, and support data-driven decision-making</span><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></li> </ul> <p><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span><strong><span data-contrast="auto">Work Environment</span></strong><span data-ccp-props="{"201341983":0,"335559739":0,"335559740":240}"> </span></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="11" data-list-defn-props="{"335552541":1,"335559685":1080,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="9" data-aria-level="1"><span data-contrast="auto">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.</span><span data-ccp-props="{}"> </span></li> </ul> <p><strong><span data-contrast="auto">Physical Demands</span></strong><span data-ccp-props="{}"> </span></p> <p><span data-contrast="auto">This is a sedentary role requiring prolonged periods of sitting while working at a computer. Physical demands include:</span><span data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> <ul> <li data-leveltext="" data-font="Symbol" data-listid="5" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1"><span data-contrast="auto">Sitting for extended periods (up to 8 hours per day)</span><span data-ccp-props="{"335559739":0}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="5" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1"><span data-contrast="auto">Repetitive use of hands and fingers for typing and mouse operation</span><span data-ccp-props="{"335559739":0}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="5" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1"><span data-contrast="auto">Visual acuity for reading computer screens and documents</span><span data-ccp-props="{"335559739":0}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="5" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1"><span data-contrast="auto">Ability to communicate effectively via phone and video calls</span><span data-ccp-props="{"335559739":0}"> </span></li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="5" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="5" data-aria-level="1"><span data-contrast="auto">Occasional lifting of up to 10 pounds (office supplies, equipment)</span><span data-ccp-props="{"335559739":0}"> </span></li> </ul> <p><span data-contrast="auto">Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.</span><span data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> <p> </p> <p><span data-ccp-props="{"335559738":240,"335559739":240}">#LI-REMOTE</span></p><div class="content-pay-transparency"><div class="pay-input"><div class="title">Pay Transparency, Budgeted Range</div><div class="pay-range"><span>$96,000</span><span class="divider">—</span><span>$118,000 USD</span></div></div></div><div class="content-conclusion"><div class="column _8-col center-element _12-col-tab"> <div class="margin-bottom margin-24"> <h3 class="heading-l">A culture that plays to win, because patients are counting on us</h3> </div> </div> <div class="column _8-col _12-col-tab"> <p>At GeneDx, we're driven by urgency and purpose: helping patients get diagnosed earlier. Our mission, to empower everyone to live their healthiest life through genomics, drives our team to make a tangible impact each day – and shapes our culture where high standards, strong teamwork, and meaningful ownership are the norm. We act with intention, support one another, and deliver work we're proud to put our names on.<br><br><strong>Here’s what you can expect day to day:</strong><br><br>1. Play like a champion (step up, redefine what’s possible, own it)</p> <p class="text-l">We bring energy, focus, and a bias for action. We step up, take initiative, and deliver on our commitments – with quality, speed, and care.<br><br></p> <div class="card-number">2. Think bigger (stretch beyond, courage not consensus)</div> <p class="text-l">We push past the obvious. We challenge assumptions, raise the bar, and make thoughtful, decisive calls — choosing progress over perfection.<br><br></p> <div class="card-number">3. Grow fast (be curious, speak up, be agile)</div> <p class="text-l">We stay curious, ask questions, and share direct feedback with respect. We adapt quickly and keep learning through collaboration and continuous improvement.<br><br>If you’re motivated by meaningful work, a fast-moving environment, and teammates who care deeply about outcomes, you’ll thrive at GeneDx.</p> </div> <div>At GeneDx, we believe in taking care of our people. 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.</div> <p>We welcome everyone regardless of their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, gender, gender identity, sexual orientation, protected veteran status, disability, age, and other characteristics protected by law.</p> <p><strong>GeneDx is a place where people from all backgrounds can make an impact.</strong></p> <p><strong><br></strong>All privacy policy information can be found <a href="https://www.genedx.com/privacy" target="_blank">here</a>.</p></div>
Salary Context
Similar Operations roles on LokerDollar pay around $193k/yr (range $12k–1000k/yr, n=196 active listings).
Openness not stated by employer — check the listing
Frequently asked questions
- Is Manager, Medicaid Policy & Operations at GeneDx a remote job?
- Yes, Manager, Medicaid Policy & Operations at GeneDx is remote, but the employer did not state which countries can apply. Check the listing before applying.
- What is the salary for Manager, Medicaid Policy & Operations at GeneDx?
- The listed pay range for this role is $96k–118k/yr.
- What type of employment is Manager, Medicaid Policy & Operations at GeneDx?
- This is a full time position.
- How do I apply?
- Click the "Apply" button on this page to go to the official application at GeneDx.
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