Manager, Medicaid Policy & Operations
New
G
GeneDxHealthcare Genomics
RemoteFull-TimeManager
Salary96,000 - 118,000 USD per year
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Job Details
- Experience
- 4–7+ years
- Required Skills
- Data AnalysisMicrosoft Excel
Requirements
- 4–7+ years of experience in Medicaid policy or Medicaid operations.
- Strong proficiency in Excel and experience working with claims-level datasets.
- Ability to analyze claims data and identify drivers of denials or reimbursement variability.
- Strong analytical, organizational, and communication skills.
- Bachelor’s degree in healthcare, public policy, business, or related field preferred.
- Experience working within a Medicaid agency or managed care organization strongly preferred.
- Hands-on experience with EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) programs strongly preferred.
Responsibilities
- Monitor state Medicaid fee schedules, rate updates, public meeting calendars, and program requirements across U.S. Medicaid programs.
- Serve as an internal subject matter expert on state-specific Medicaid reimbursement requirements, including EPSDT processes and prior authorization.
- Partner with Medicaid Policy Directors to submit policy change requests and uncover state-specific processes.
- Support Regional Market Access Directors by synthesizing data to inform reimbursement and contracting strategies.
- Maintain centralized tracking of Medicaid reimbursement issues, payment variances, and policy questions.
- Translate state Medicaid policy and reimbursement requirements into actionable guidance for the Revenue Cycle Team.
- Analyze claims data, denial trends, and payment variances to identify root causes and recommend process improvements.
- Develop and maintain state- and payor-specific standard operating procedures and workflows.
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