happy-sleep - Happy Health - Senior Manager, RCM & Compliance Operations
Requirements
• 6+ years of healthcare RCM experience, with demonstrated ownership across VOB, claims, and/or credentialing • Working knowledge of medical billing for DME, dental-in-medical, or specialty telehealth (OAT experience a strong plus) • Hands-on familiarity with HCPCS/CPT coding, EOB interpretation, and payer portal workflows • Experience partnering with Product or Engineering teams to translate RCM requirements into system functionality • Strong Excel/Google Sheets skills — pivot tables, lookups, and reporting are everyday tools • Demonstrated ability to document processes and build SOPs from scratch • Comfort operating in a high-autonomy, high-ambiguity environment • Experience with E0486 and K1027 billing specifically • Familiarity with PC/MSO structures and multi-state corporate compliance • Exposure to credentialing in medical networks (CAQH, PECOS, payer-specific applications) • Experience with clearinghouses and EMRs such as Candid, Healthie, Canvas, or Athena • Prior work with vendors like Candid, Stedi, Healthie, or similar eligibility/e-prescribing platforms
Responsibilities
• Verification of Benefits - Process Structure & Execution • Build on and formalize existing VOB processes, including SOPs, training materials, QA workflows, and escalation paths for complex benefit scenarios (CPT 95800, E0486, K1027, patient responsibility calculations, DME carve-outs, etc.) • Perform VOBs directly when needed — during volume spikes, on escalated cases, or as part of QA spot-checks • Partner with vendors (e.g., Stedi, Candid, Aarogram) to optimize automated eligibility workflows and troubleshoot data quality issues • Develop and maintain VOB decision trees and payer-specific quirk documentation • Claims Operations Support • Jump into claims work when the team needs coverage including payer follow-up, and root-cause analysis • Identify patterns in denials and feed insights back into VOB, credentialing, and product workflows • Product Partnership - RCM Systems Integration • Work directly with the Product team to embed RCM logic across the full patient funnel: • Top of funnel: eligibility checks, benefit display, patient-facing cost estimates • Middle of funnel: prior auth workflows, documentation capture, clinical-to-billing handoffs • Bottom of funnel: claims submission, denial routing, patient billing, AR workflows • Translate RCM requirements into product specs; review designs and test releases from an RCM accuracy standpoint • Act as the standing RCM voice in product planning cycles • Network Management - Happy & Partner Network • Assist with ongoing management of both the Happy provider network and the partner networks, including network status tracking, panel changes, and performance tracking • Flag network gaps tied to geographic expansion or payer contracting priorities • Credentialing Support • Step in to update credentialing documents, CAQH profiles, and payer applications when the credentialing workload requires backup • Help maintain credentialing SOPs and checklists • Compliance & Corporate Filings • Assist with multi-state corporate compliance work, including foreign qualification filings, annual reports, registered agent coordination, and entity maintenance across the PC/MSO structure • Support BAA, MSA, and vendor agreement reviews as a second set of eyes • Track regulatory changes affecting telehealth, DME/OAT billing, and dental-in-medical-network billing • Reporting & Analysis • Build ad hoc reports and pivot tables on VOB throughput, claims performance, credentialing status, and network composition • Translate operational data into recommendations for leadership
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