Senior Manager, RCM & Compliance Operations

3 weeks 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

  • Build and formalize verification of benefits processes, including SOPs, training materials, QA workflows, and escalation paths.
  • Perform verification of benefits work directly for volume spikes, escalated cases, and QA spot-checks.
  • Partner with eligibility and billing vendors to improve automated workflows and resolve data quality issues.
  • Develop and maintain VOB decision trees and payer-specific documentation for unusual benefit scenarios.
  • Provide backup support for claims operations, including payer follow-up and root-cause analysis of denials.
  • Identify denial patterns and feed insights back into verification, credentialing, and product workflows.
  • Work with Product to embed RCM logic across eligibility, prior authorization, documentation capture, claims submission, denial routing, patient billing, and accounts receivable workflows.
  • Translate RCM requirements into product specifications and review designs and releases for billing accuracy.
  • Support management of provider and partner networks, including status tracking, panel changes, performance tracking, and gap identification.
  • Assist with credentialing, corporate compliance, agreement review, reporting, and analysis as needed.

Requirements

  • 6+ years of healthcare RCM experience with ownership across verification of benefits, claims, and/or credentialing.
  • Startup experience.
  • Working knowledge of medical billing for DME, dental-in-medical, or specialty telehealth; OAT experience is 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 or Google Sheets skills, including pivot tables, lookups, and reporting.
  • Demonstrated ability to document processes and build SOPs from scratch.
  • Comfort working in a high-autonomy, high-ambiguity environment.
  • Experience with E0486 and K1027 billing, preferred.
  • Familiarity with PC/MSO structures and multi-state corporate compliance, preferred.
  • Exposure to credentialing in medical networks such as CAQH, PECOS, and payer-specific applications, preferred.
  • Experience with clearinghouses and EMRs such as Candid, Healthie, Canvas, or Athena, preferred.
  • Prior work with vendors like Candid, Stedi, Healthie, or similar eligibility/e-prescribing platforms, preferred.

Benefits

  • Remote full-time role.
  • Salary range of $120,000 to $125,000 per year.

Interested in this position?

Apply directly on the company website

Apply Now

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