Manager, Medicaid Policy & Operations

GeneDx (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. GeneDx 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 www.genedx.com.

Summary

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.

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.

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
• 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

People Manager

No

Education, Experience, and Skills

• 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

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. 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.

Physical Demands

This is a sedentary role requiring prolonged periods of sitting while working at a computer. Physical demands include:

• 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)

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

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