Manager, Medicaid Policy & Operations (Healthcare)

TL;DR

Manager, Medicaid Policy & Operations (Healthcare): Monitoring and operationalizing state Medicaid reimbursement requirements across the US with an accent on policy analysis and claims data. Focus on identifying reimbursement patterns, reducing denial trends, and translating complex state policies into actionable guidance for revenue cycle teams.

Location: Remote (Must be based in the US)

Salary: $96,000 - $118,000 USD

Company

hirify.global is a genomics company providing personalized health insights to inform diagnosis, direct treatment, and improve drug discovery for rare diseases.

What you will do

• Monitor state Medicaid fee schedules, rate updates, and program requirements to identify changes affecting reimbursement.
• Act as the internal subject matter expert on state-specific Medicaid reimbursement, including EPSDT processes and claim submission.
• Analyze claims data and denial trends to identify root causes and recommend data-informed process improvements.
• Develop and maintain state- and payor-specific standard operating procedures (SOPs) and reference materials.
• Partner with Market Access and Revenue Cycle teams to translate policies into clear operational guidance.
• Synthesize operational trends into recommendations for leadership to inform strategic decision-making.

Requirements

• Bachelor’s degree in healthcare, public policy, business, or a related field.
• 4–7+ years of experience in Medicaid policy or Medicaid operations.
• Must be based in the United States.
• Strong proficiency in Excel and experience working with claims-level datasets to identify trends.
• Experience working within a Medicaid agency or managed care organization (MCO) is strongly preferred.
• Hands-on experience with EPSDT programs is strongly preferred.

Culture & Benefits

• Fully remote work environment with a home-office setup.
• Purpose-driven culture focused on helping patients get diagnosed earlier through genomics.
• High-performance environment emphasizing ownership, bias for action, and continuous learning.
• Competitive compensation and benefits reflecting local market practices.
• Inclusive workplace welcoming people from all backgrounds.