Manager, Payor Operations

🕒 Julho 29

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $145.000 - $155.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

⚙️ Operações

👻 Score fantasma 0%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Happy Health

SiteLinkedInTodas as Vagas

11 - 50 funcionários

🏥 Saúde

🔧 Hardware

🤖 Inteligência Artificial

💰 $60.000.000 Series A - Happy Health em 2022-08

Healthcare • Hardware • Artificial Intelligence

A Happy Health é uma empresa de medicina do sono focada no consumidor, que opera a plataforma Happy Sleep. Ela combina um dispositivo vestível para monitoramento do sono aprovado pela FDA (o Happy Ring) para testes de sono clínicos em casa, com atendimento virtual prestado por médicos do sono certificados e uma equipe de cuidados coordenados. A empresa oferece testes de sono em casa baseados em prescrição, opções de tratamento personalizadas (CPAP, dispositivos customizados, cirurgia, intervenções comportamentais), monitoramento noturno e cuidados contínuos, rastreamento de saúde aprimorado por IA, consultas virtuais no mesmo dia e trabalha com as principais seguradoras em vários estados dos EUA.

Descrição

• Lead the strategy and execution to move Happy Sleep from state-by-state, payor-by-payor enrollment toward national in-network agreements with major commercial payors • Build and pitch the business case for national contracting to payor leadership — data on volume, quality, cost savings, and network adequacy and, most importantly, health outcomes • Own negotiations (or partner closely with Legal/Finance on) rates, terms, and effective dates for national agreements • Sequence and prioritize which payors to pursue first based on member volume, existing patient overlap, and strategic fit • Track and report progress on national agreement pursuit to executive leadership, including risks, blockers, and timeline • Ensure smooth operational rollout — timely provider data load, fee schedule loading, updated payer directory and internal communication so billing/RCM can execute cleanly • Directly manage a Credentialing Specialist, providing day-to-day guidance, workload prioritization, and professional development • Set clear SLAs and KPIs for credentialing turnaround time, clean application assembly, and renewal compliance, and coach the team to hit them • Continuously improve the systems, workflows, and tooling that support credentialing and payor enrollment • Ensure CAQH profiles, NPI records, state licenses, DEA registrations, are current, with proactive renewal tracking • Oversee payor enrollment for new markets and new provider onboarding, including Medicare PECOS and state Medicaid portals • Manage escalated relationships with payor provider relations reps to resolve enrollment holds, revalidation requests, and demographic disputes • Own resolution of claim denial trends tied to credentialing or enrollment issues driving root-cause fixes with RCM and Clinical Ops • Own reporting and forecasting on credentialing turnaround time, enrollment status by payor/state, and revenue at risk from credentialing gaps — presented to executive leadership

🎯 Requisitos

• 6+ 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 terms • Deep working knowledge of CAQH, PECOS, NPPES, and NCQA credentialing standards • Experience managing or mentoring at least one direct report in a credentialing/enrollment function • Experience troubleshooting and resolving claim denial trends tied to enrollment/credentialing issues in partnership with RCM • Comfort operating with executive visibility — able to translate operational detail and negotiation strategy into a clear, data-backed narrative for leadership • Strong written and verbal communication for payor negotiations, escalations, and internal reporting • Experience with sleep medicine, home sleep testing, or DME billing/coverage rules a plus

🏖️ Benefícios

• 100% premium coverage for employee's Health, Dental, and Vision Insurance. 50% premium coverage for dependents. • 401k platform • Equity in company • WFH Stipend