Manager, Payor Operations

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Happy Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

🔧 Hardware

🤖 Artificial Intelligence

💰 $60M Series A - Happy Health on 2022-08

Healthcare • Hardware • Artificial Intelligence

Happy Health is a consumer-focused sleep medicine company that operates the Happy Sleep platform. It combines an FDA-cleared medical wearable (the Happy Ring) for at-home, clinical-grade sleep testing with virtual care delivered by board-certified sleep physicians and a coordinated care team. The company offers prescription-based home sleep testing, personalized treatment options (CPAP, custom devices, surgery, behavioral interventions), nightly monitoring and ongoing care, AI-enhanced health tracking, same-day virtual appointments, and works with major insurers across most U. S. states.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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