happy-sleep - Manager, Payor Operations

• National Payor Agreements • 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 • Given 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 line • Track and report progress on national agreement pursuit to executive leadership, including risks, blockers, and timeline • Once 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 cleanly • Team Leadership • 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 • Step in on complex or escalated credentialing/enrollment cases as needed • Aid in forming responses to network managers that foster relationship building • Continuously improve the systems, workflows, and tooling that support credentialing and payor enrollment (we currently use Modio as our PDM) ) • Credentialing Oversight • Ensure CAQH profiles, NPI records, state licenses, DEA registrations, are current, with proactive renewal tracking • Ensure credentialing applications to commercial payors, Medicare, and Medicaid are submitted accurately and followed through to completion • Maintain 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 manner • Payor Enrollment & Contracting Support • Oversee payor enrollment for new markets and new provider onboarding, including Medicare PECOS and state Medicaid portals • Partner with Legal/Contracting on payor contract loading, fee schedule validation, and effective-date tracking • Manage escalated relationships with payor provider relations reps to resolve enrollment holds, revalidation requests, and demographic disputes • Payor Operations • Own 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 Ops • Ensure claims are held/released appropriately based on credentialing status, minimizing both compliance risk and delayed revenue • Monitor payor policy changes (prior auth requirements, DME/sleep study coverage criteria, telehealth coverage rules) and translate them into operational and process changes • Own reporting and forecasting on credentialing turnaround time, enrollment status by payor/state, and revenue at risk from credentialing gaps — presented to executive leadership • Cross-Functional Collaboration • Partner with Clinical Ops leadership to align provider onboarding and hiring plans with credentialing lead times and national agreement rollouts • Serve as the organization's subject-matter expert and executive-facing voice on payor requirements and national contracting strategy for sleep medicine and DME billing • 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. • Team Leadership • Payor Operations