Manager, Medicaid Policy & Operations

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 Gene Dx’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 Gene Dx’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.

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.

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 or 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.

Pay Transparency, Budgeted Range

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.

Gene Dx is a place where people from all backgrounds can make an impact.

All privacy policy information can be found here.

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