Description
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
Similar jobs
Est. 110,000 USD
About Us Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. En…
Est. 115,000 USD
About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with…
Est. 140,000 USD
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-s…
Est. 85,000 USD
About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with…
Est. 55,000 USD
*Now offering Sign On Bonus with a total payout of $1500*
Est. 55,000 USD
*Now offering Sign On Bonus with a total payout of $1500*
Est. 85,000 USD
Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support…
Est. 40,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 140,000 USD
Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support…
Est. 40,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 120,000 USD
Company Description Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in ca…
Est. 40,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 120,000 USD
Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in care and develop diffe…
Est. 55,000 USD
SUMMARY An Assistant Office Manager is a highly engaged leader that possess a high level of acuity in business acumen and is focused on developing a patient-focused team that is goal oriented.
Est. 115,000 USD
About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 40,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 120,000 USD
About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with…
Est. 35,000 USD
SUMMARY A Front Office Specialist is trained to act as the first point of contact, setting the tone for a world class Total Patient Experience. This employee will also perform the necessary administrative responsibilitie…
Est. 120,000 USD
Company Description Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in ca…
Est. 140,000 USD
Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support…
Est. 120,000 USD
Axsome Therapeutics is a biopharmaceutical company leading a new era in the treatment of central nervous system (CNS) conditions. We deliver scientific breakthroughs by identifying critical gaps in care and develop diffe…
Est. 55,000 USD
SUMMARY An Office Manager will achieve a world class Total Patient Experience that both maximizes the retail sales but also supports the patients’ medical needs. Responsible for the overall sales and profitability of an…
Est. 55,000 USD
SUMMARY An Office Manager will achieve a world class Total Patient Experience that both maximizes the retail sales but also supports the patients’ medical needs. Responsible for the overall sales and profitability of an…
Est. 55,000 USD
SUMMARY An Office Manager will achieve a world class Total Patient Experience that both maximizes the retail sales but also supports the patients’ medical needs. Responsible for the overall sales and profitability of an…