Manager, Payor Operations

Key Responsibilities:

• 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 using data on volume, quality, cost savings, and health outcomes.
• Own negotiations on rates, terms, and effective dates for national agreements, and sequence payors based on member volume and strategic fit.

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 and renewal compliance, and coach the team to hit them.
• Step in on complex credentialing or enrollment cases and aid in forming responses to network managers to foster relationships.

Credentialing Oversight:

• Ensure CAQH profiles, NPI records, state licenses, and 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 across every provider and payor with escalation paths for at-risk timelines.

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 on payor requirements and national contracting strategy for sleep medicine.
• Troubleshoot claim denial trends tied to credentialing issues and drive root-cause fixes with RCM and Clinical Ops.