Manager, Payor Operations

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

• 6+ years of experience in healthcare credentialing, payor enrollment, or payor/provider operations, including experience negotiating or contracting directly with national/commercial payors (healthcare, telehealth, or DME experience strongly preferred)

• Direct experience building the business case for and/or securing national or multi-state in-network agreements — you understand payor decision-making, network adequacy considerations, and what moves a payor from regional to national terms

• Deep working knowledge of CAQH, PECOS, NPPES, and NCQA credentialing standards

• Experience managing or mentoring at least one direct report in a credentialing/enrollment function

• Experience troubleshooting and resolving claim denial trends tied to enrollment/credentialing issues in partnership with RCM

• Comfort operating with executive visibility — able to translate operational detail and negotiation strategy into a clear, data-backed narrative for leadership

• Strong written and verbal communication for payor negotiations, escalations, and internal reporting

• Experience with sleep medicine, home sleep testing, or DME billing/coverage rules a plus

• Existing relationships or track record with major national payors (UnitedHealthcare, Aetna, Cigna, Elevance, etc.)

• Prior experience building credentialing/payor ops functions at a fast-growing healthcare startup, ideally through a period of multi-state or multi-market expansion

• Experience with multi-state licensure and telehealth-specific payor rules

• Familiarity with revenue cycle management (RCM) workflows and how credentialing intersects with clean-claim submission

• A high-visibility mandate: you'll be the person who takes Happy Sleep from regional payor patchwork to national in-network status

• Direct, visible impact — your work literally determines whether providers can see patients and get paid, and how far Happy Sleep can scale

• A fast-moving, low-ego team that values ownership and problem-solving over process for its own sake

• Executive visibility and a clear path to grow the scope of this role as national agreements land and the company scales