Happy Health is revolutionizing sleep medicine delivery through our comprehensive telehealth platform. We've eliminated the traditional barriers to sleep care – no more waiting months for appointments or spending uncomfortable nights in sleep labs. Our patients receive FDA-cleared home sleep testing via Happy Ring, connect with board-certified sleep specialists, and when required, begin evidence-based treatment within just 5 days. Ongoing physiological data monitoring with the Happy Ring enables real-time condition management, combination therapies, and drives measurable outcomes. Happy Ring represents the future of sleep diagnostics: an FDA-cleared medical device integrating advanced biometric sensors with AI-powered analysis to deliver highly accurate diagnostics and longitudinal management at home. For sleep medicine physicians, this means you'll have access to high-quality diagnostic data that empowers you to make confident clinical decisions for your patients, and integrate multimodal treatments that focus on root-cause solutions. About the RoleHappy Sleep is looking for a Manager of Payor Operations to lead our credentialing and payor operations function — with a primary mandate to secure national payor agreements that let Happy Sleep operate at scale across markets. You'll manage a Credentialing Specialist who handles day-to-day credentialing execution, while you focus on the strategic relationships, contracting, and negotiation work that gets Happy Sleep in-network nationally rather than payor-by-payor, state-by-state.You'll be the connective tissue between clinical operations, revenue cycle, and insurance payors — making sure nothing falls through the cracks that could delay a provider's ability to bill or a patient's ability to be seen, while also driving the bigger swing: converting a patchwork of regional payor relationships into durable, national agreements.This role is a strong fit for someone who has run credentialing/payor ops hands-on, has direct experience negotiating with national payors, and is energized by moving between "in the weeds" problem-solving and high-stakes payor relationship management. You'll report to VP of Finance and will have significant latitude to shape how this function is built.What You'll DoNational Payor AgreementsLead the strategy and execution to move Happy Sleep from state-by-state, payor-by-payor enrollment toward national in-network agreements with major commercial payorsBuild and pitch the business case for national contracting to payor leadership — data on volume, quality, cost savings, and network adequacy and, most importantly, health outcomesOwn negotiations (or partner closely with Legal/Finance on) rates, terms, and effective dates for national agreementsSequence and prioritize which payors to pursue first based on member volume, existing patient overlap, and strategic fitGiven Happy’s model, some payers gravitate toward a vendor or bundled arrangement with a path to a value based, shared savings model. You’re prepared to embrace this nuance and get it across the finish lineTrack and report progress on national agreement pursuit to executive leadership, including risks, blockers, and timelineOnce agreements are signed, ensure smooth operational rollout — timely provider data load, fee schedule loading, updated payer directory and internal communication so billing/RCM can execute cleanlyTeam LeadershipDirectly manage a Credentialing Specialist, providing day-to-day guidance, workload prioritization, and professional developmentSet clear SLAs and KPIs for credentialing turnaround time, clean application assembly , and renewal compliance, and coach the team to hit themStep in on complex or escalated credentialing/enrollment cases as neededAid in forming responses to network managers that foster relationship buildingContinuously improve the systems, workflows, and tooling that support credentialing and payor enrollment (we currently use Modio as our PDM) )Credentialing OversightEnsure CAQH profiles, NPI records, state licenses, DEA registrations, are current, with proactive renewal trackingEnsure credentialing applications to commercial payors, Medicare, and Medicaid are submitted accurately and followed through to completionMaintain an accurate, real-time credentialing tracker/CRM across every provider and payor, with escalation paths for at-risk timelines (you can use Modio for this or build a tracker)Ensure re-credentialing requests are met in a timely mannerPayor Enrollment & Contracting SupportOversee payor enrollment for new markets and new provider onboarding, including Medicare PECOS and state Medicaid portalsPartner with Legal/Contracting on payor contract loading, fee schedule validation, and effective-date trackingManage escalated relationships with payor provider relations reps to resolve enrollment holds, revalidation requests, and demographic disputesPayor OperationsOwn resolution of claim denial trends tied to credentialing or enrollment issues (e.g., "provider not on file"), driving root-cause fixes with RCM and Clinical OpsEnsure claims are held/released appropriately based on credentialing status, minimizing both compliance risk and delayed revenueMonitor payor policy changes (prior auth requirements, DME/sleep study coverage criteria, telehealth coverage rules) and translate them into operational and process changesOwn reporting and forecasting on credentialing turnaround time, enrollment status by payor/state, and revenue at risk from credentialing gaps — presented to executive leadershipCross-Functional CollaborationPartner with Clinical Ops leadership to align provider onboarding and hiring plans with credentialing lead times and national agreement rolloutsServe as the organization's subject-matter expert and executive-facing voice on payor requirements and national contracting strategy for sleep medicine and DME billingWhat You'll Bring6+ years of experience in healthcare credentialing, payor enrollment, or payor/provider operations, including experience negotiating or contracting directly with national/commercial payors (healthcare, telehealth, or DME experience strongly preferred)Direct experience building the business case for and/or securing national or multi-state in-network agreements — you understand payor decision-making, network adequacy considerations, and what moves a payor from regional to national termsDeep working knowledge of CAQH, PECOS, NPPES, and NCQA credentialing standardsExperience managing or mentoring at least one direct report in a credentialing/enrollment functionExperience troubleshooting and resolving claim denial trends tied to enrollment/credentialing issues in partnership with RCMComfort operating with executive visibility — able to translate operational detail and negotiation strategy into a clear, data-backed narrative for leadershipStrong written and verbal communication for payor negotiations, escalations, and internal reportingExperience with sleep medicine, home sleep testing, or DME billing/coverage rules a plusNice to HaveExisting relationships or track record with major national payors (UnitedHealthcare, Aetna, Cigna, Elevance, etc.)Prior experience building credentialing/payor ops functions at a fast-growing healthcare startup, ideally through a period of multi-state or multi-market expansionExperience with multi-state licensure and telehealth-specific payor rulesFamiliarity with revenue cycle management (RCM) workflows and how credentialing intersects with clean-claim submissionWhy Join Happy SleepA high-visibility mandate: you'll be the person who takes Happy Sleep from regional payor patchwork to national in-network statusDirect, visible impact — your work literally determines whether providers can see patients and get paid, and how far Happy Sleep can scaleA fast-moving, low-ego team that values ownership and problem-solving over process for its own sakeExecutive visibility and a clear path to grow the scope of this role as national agreements land and the company scalesWork Environment:The team is remote, with a physical office in Austin, TX. Direct peers are distributed throughout the continental US. This role is expected to operate with a high degree of autonomy and leadership in a distributed environment.Benefits:100% premium coverage for employee's Health, Dental, and Vision Insurance. 50% premium coverage for dependents.401k platformEquity in companyWFH Stipend
8 days ago