Manager, Payor Operations

45 minutes ago
Full-time
Senior
Operations
Happy Health

Happy Health

Happy Health is a technology company located in Austin, Texas, focused on a consumer-first healthcare platform that specializes in at-home sleep diagnostics and personalized treatment. The company employs between 201 and 500 people and aims to empower patients through its innovative digital health solutions. Its flagship program, Happy Sleep, launched in 2024, provides results in as little as five days using FDA-cleared devices and AI-driven insights. The Happy Sleep platform offers comprehensive sleep health services, including home sleep tests, virtual consultations with board-certified sleep doctors, and personalized care plans. The Happy Ring, an FDA-cleared smart ring, serves as a clinical-grade device for accurate sleep testing and health monitoring. Happy Health also provides various treatment options tailored to individual lifestyles and budgets, with real-time data to adjust care plans dynamically. The platform extends its services to chronic condition management, integrating AI for notifications and clinical support.

information technology & services
201-500
Founded 2019
$60M raised

Description

  • Lead the strategy and execution for national payor agreements with major commercial payors.
  • Build business cases for national contracting using volume, quality, cost, network adequacy, and outcomes data.
  • Negotiate rates, terms, effective dates, and bundled or value-based arrangements with payors.
  • Prioritize payors based on member volume, patient overlap, and strategic fit.
  • Manage a Credentialing Specialist and provide guidance, prioritization, and professional development.
  • Set and monitor SLAs and KPIs for credentialing turnaround, clean applications, and renewals.
  • Oversee credentialing accuracy and renewal tracking for CAQH, NPI, state licenses, and DEA registrations.
  • Manage payor enrollment for new markets, new providers, Medicare PECOS, and state Medicaid portals.
  • Resolve claim denials, enrollment holds, and provider relation escalations with RCM, Legal, and Clinical Ops.
  • Own reporting on enrollment status, turnaround time, and revenue at risk for executive leadership.

Requirements

  • 6+ years of experience in healthcare credentialing, payor enrollment, or payor/provider operations.
  • Experience negotiating or contracting directly with national or commercial payors.
  • Experience building the case for or securing national or multi-state in-network agreements.
  • Deep working knowledge of CAQH, PECOS, NPPES, and NCQA credentialing standards.
  • Experience managing or mentoring at least one direct report in a credentialing or enrollment function.
  • Experience troubleshooting claim denials tied to enrollment or credentialing issues with RCM.
  • Strong written and verbal communication for negotiations, escalations, and internal reporting.
  • Comfort operating with executive visibility and presenting data-backed recommendations.
  • Healthcare, telehealth, or DME experience strongly preferred.
  • Experience with sleep medicine, home sleep testing, or DME billing and coverage rules is a plus.
  • Existing relationships with major national payors such as UnitedHealthcare, Aetna, Cigna, or Elevance is a plus.
  • Experience building credentialing or payor ops functions at a fast-growing healthcare startup is a plus.
  • Experience with multi-state licensure and telehealth-specific payor rules is a plus.

Benefits

  • High-visibility role with clear ownership over national payor expansion.
  • Direct impact on provider access, billing, and company scale.
  • Fast-moving, low-ego team culture focused on ownership and problem-solving.
  • Executive visibility with room to expand the role as the company grows.

Interested in this position?

Apply directly on the company website

Apply Now

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