Manager, Payor Operations

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. 

About the Role

Happy Sleep is looking for a Manager of Payor Operations to lead our credentialing and payor operations function — with a primary mandate to secure national payor agreements that let Happy Sleep operate at scale across markets. You'll manage a Credentialing Specialist who handles day-to-day credentialing execution, while you focus on the strategic relationships, contracting, and negotiation work that gets Happy Sleep in-network nationally rather than payor-by-payor, state-by-state.

You'll be the connective tissue between clinical operations, revenue cycle, and insurance payors — making sure nothing falls through the cracks that could delay a provider's ability to bill or a patient's ability to be seen, while also driving the bigger swing: converting a patchwork of regional payor relationships into durable, national agreements.

This role is a strong fit for someone who has run credentialing/payor ops hands-on, has direct experience negotiating with national payors, and is energized by moving between "in the weeds" problem-solving and high-stakes payor relationship management. You'll report to VP of Finance and will have significant latitude to shape how this function is built.

What You'll Do

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 an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.