[Hiring] Manager, Medicaid Policy & Operations @GeneDx

Role Description

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.

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.

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.
• 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.
• 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.
• Translate state Medicaid policy and reimbursement requirements into clear, actionable guidance for the Revenue Cycle Team.
• Analyze claims data, denial trends, payment variances, and prior authorization outcomes to identify root causes and recommend data-informed process improvements.
• Develop and maintain state- and payor-specific standard operating procedures, reference materials, and workflows.
• Synthesize reimbursement insights and operational trends into recommendations for Market Access leadership.

Qualifications

• 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.
• Strong analytical, organizational, and communication skills.
• Strong proficiency in Excel and comfort working with claims-level datasets.

Work Environment

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.

Physical Demands

• Sitting for extended periods (up to 8 hours per day).
• Repetitive use of hands and fingers for typing and mouse operation.
• Visual acuity for reading computer screens and documents.
• Ability to communicate effectively via phone and video calls.
• Occasional lifting of up to 10 pounds (office supplies, equipment).

Pay Transparency, Budgeted Range

$96,000 — $118,000 USD

Company Description

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.

• We bring energy, focus, and a bias for action.
• We push past the obvious and challenge assumptions.
• We stay curious, ask questions, and share direct feedback.