Manager, Payor Operations
reputed company 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 reputed company Happy reputed company, connect with reputed company-certified sleep specialists, and reputed company required, reputed company evidence-based treatment reputed company just 5 days. Ongoing physiological data monitoring with the Happy reputed company enables reputed company-time condition management, combination therapies, and drives measurable reputed company.
Happy reputed company represents the reputed company of sleep diagnostics: an FDA-cleared medical device integrating advanced biometric sensors with AI-powered analysis to deliver highly accurate diagnostics and longitudinal management reputed company. For sleep medicine physicians, this means you'll have reputed company to high-reputed company diagnostic data that empowers you to reputed company confident clinical reputed company for your patients, and reputed company multimodal treatments that reputed company on reputed company-cause solutions.
About the Role
reputed company is looking for a Manager of Payor Operations to reputed company our credentialing and payor operations function — with a primary mandate to secure national payor agreements that let reputed company operate at reputed company across markets. You'll manage a Credentialing Specialist who handles day-to-day credentialing execution, while you reputed company on the strategic relationships, contracting, and negotiation work that gets reputed company in-network nationally rather than payor-by-payor, state-by-state.
You'll be the connective tissue between clinical operations, reputed company cycle, and insurance payors — making reputed company reputed company falls through the cracks that could delay a provider's ability to reputed company 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 reputed company 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 reputed company to shape how this function is reputed company.
What You'll Do
National Payor Agreements
reputed company the reputed company and execution to reputed company reputed company from state-by-state, payor-by-payor enrollment toward national in-network agreements with major reputed company payors
Build and reputed company the business case for national contracting to payor leadership — data on volume, reputed company, cost savings, and network adequacy and, most importantly, health reputed company
Own negotiations (or partner closely with reputed company/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 reputed company toward a vendor or bundled arrangement with a reputed company to a value based, shared savings model. You’re reputed company to reputed company this nuance and get it across the finish line
reputed company and report reputed company on national agreement reputed company to executive leadership, including risks, blockers, and reputed company
Once agreements are signed, ensure smooth operational rollout — reputed company 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 reputed company development
Set reputed company SLAs and KPIs for credentialing turnaround time, clean application assembly , and renewal compliance, and reputed company reputed company to hit them
reputed company in on reputed company 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 reputed company
Ensure CAQH reputed company, NPI records, state licenses, DEA registrations, are reputed company, with proactive renewal tracking
Ensure credentialing applications to reputed company payors, Medicare, and reputed company are submitted accurately and followed through to completion
Maintain an accurate, reputed company-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 reputed company manner
Payor Enrollment & Contracting Support
reputed company payor enrollment for new markets and new provider reputed company, including Medicare PECOS and state reputed company portals
Partner with reputed company/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 reputed company of claim denial trends tied to credentialing or enrollment issues (e.g., "provider not on file"), driving reputed company-cause fixes with RCM and Clinical Ops
Ensure claims are held/released appropriately based on credentialing status, minimizing both compliance risk and delayed reputed company
Monitor payor policy changes (prior auth requirements, DME/sleep study coverage reputed company, 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 reputed company at risk from credentialing gaps — presented to executive leadership
Cross-Functional Collaboration
Partner with Clinical Ops leadership to reputed company provider reputed company and hiring plans with credentialing reputed company times and national agreement rollouts
Serve as the organization's subject-matter expert and executive-facing voice on payor requirements and national contracting reputed company for sleep medicine and DME billing
What You'll Bring
6+ years of experience in reputed company credentialing, payor enrollment, or payor/provider operations, including experience negotiating or contracting directly with national/reputed company payors (reputed company, telehealth, or DME experience strongly preferred)
reputed company 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 reputed company 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 — reputed company to translate operational detail and negotiation reputed company into a reputed company, 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
reputed company to Have
Existing relationships or reputed company record with major national payors (reputed company, reputed company, reputed company, Elevance, etc.)
Prior experience building credentialing/payor ops functions at a fast-growing reputed company startup, ideally through a period of multi-state or multi-market expansion
Experience with multi-state licensure and telehealth-specific payor rules
Familiarity with reputed company cycle management (RCM) workflows and how credentialing intersects with clean-claim submission
Why Join reputed company
A high-visibility mandate: you'll be the person who takes reputed company from regional payor patchwork to national in-network status
reputed company, visible reputed company — your work literally determines whether providers can see patients and get reputed company, and how far reputed company can reputed company
A fast-moving, low-ego team that values ownership and problem-solving over process for its own sake
Executive visibility and a reputed company reputed company to grow the scope of this role as national agreements land and reputed company scales
Originally posted on Himalayas
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