Manager, Medicaid Policy & Operations

Responsibilities

• Monitor state Medicaid fee schedules, rate updates, and program requirements to identify changes affecting reimbursement
• Serve as an internal subject matter expert on state-specific Medicaid reimbursement, EPSDT processes, and prior authorization
• Partner with Medicaid Policy Directors on policy change requests and issue escalation
• Support Regional Market Access Directors by synthesizing data and research for contracting strategies
• Maintain centralized tracking of Medicaid reimbursement issues, payment variances, and policy questions
• Translate Medicaid policy into actionable guidance for the Revenue Cycle Team
• Analyze claims data and denial trends to identify root causes and recommend process improvements
• Develop and maintain state-specific standard operating procedures and workflows
• Synthesize reimbursement insights to inform Market Access leadership decision-making

Requirements

• 4–7+ years of experience in Medicaid policy or Medicaid operations
• Experience analyzing claims data and identifying drivers of denials or reimbursement variability
• Proficiency in Excel and comfort working with claims-level datasets
• Ability to use research and external outreach to develop standardized processes
• Strong analytical, organizational, and communication skills

Preferred Qualifications

• Bachelor’s degree in healthcare, public policy, business, or related field
• Experience working within a Medicaid agency or managed care organization
• Hands-on experience with EPSDT programs

About the Company

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.