Manager, Medicaid Policy – Operations

🕒 il y a 24 jours

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GeneDx

Site WebLinkedInTous les Emplois

1001 - 5000 employés

🧬 Biotechnologie

🏥 Santé

🤖 Intelligence artificielle

Biotechnology • Healthcare • Artificial Intelligence

Chez GeneDx, nous croyons que chacun mérite des soins médicaux personnalisés et ciblés – et que tout commence par un diagnostic génétique. Forts de l'un des plus grands ensembles de données au monde sur les maladies rares, nos tests d'exome et de génome, leaders dans l'industrie, traduisent des données génomiques complexes en réponses cliniques permettant de créer des plans de santé personnalisés, d'accélérer la découverte de médicaments et d'améliorer l'efficacité des systèmes de santé. Tout commence par un simple test.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• Competitive compensation and benefits that reflect local market practices and legal requirements • Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities