United States onlyAbout Happy Health
Happy Health is a one-stop comprehensive sleep medicine platform. In just 5 days, patients can get an FDA-cleared sleep test (on Happy Ring), see a Sleep Medicine provider, and begin personalized care – all from the comfort of their own home.
Happy Ring is an FDA cleared medical device that combines proprietary, next-gen biometric sensors and generative AI to deliver industry-leading accuracy. Whether you’re diagnosing a sleep condition or monitoring health at home, precision healthcare begins with better data.
Position Summary
The Senior Manager, RCM & Compliance Operations is the operational right hand to the Sr. Executive Director of Payer Operations & Corporate Compliance. Your work sits at the intersection of clinical operations, payer contracting, and multi-state regulatory compliance. This role is a hybrid builder/operator: part RCM process architect, part compliance generalist, and part cross-functional liaison to Product. You will deepen the structure around our verification of benefits (VOB) workflows, step into claims when volume or complexity demands it, partner with Product to embed RCM logic into top-, mid-, and bottom-of-funnel systems, and assist with network management across both the Happy and partner networks.
This is a high-leverage seat for someone who thrives in ambiguity, can move between the weeds of a denied claim and the whiteboard of a system design conversation, and wants to grow into a director-level scope.
Key Responsibilities
Build on and formalize existing VOB processes, including SOPs, training materials, QA workflows, and escalation paths for complex benefit scenarios (CPT 95800, E0486, K1027, patient responsibility calculations, DME carve-outs, etc.)
Perform VOBs directly when needed — during volume spikes, on escalated cases, or as part of QA spot-checks
Partner with vendors (e.g., Stedi, Candid, Aarogram) to optimize automated eligibility workflows and troubleshoot data quality issues
Develop and maintain VOB decision trees and payer-specific quirk documentation
Jump into claims work when the team needs coverage including payer follow-up, and root-cause analysis
Identify patterns in denials and feed insights back into VOB, credentialing, and product workflows
Work directly with the Product team to embed RCM logic across the full patient funnel:
Top of funnel: eligibility checks, benefit display, patient-facing cost estimates
Middle of funnel: prior auth workflows, documentation capture, clinical-to-billing handoffs
Bottom of funnel: claims submission, denial routing, patient billing, AR workflows
Translate RCM requirements into product specs; review designs and test releases from an RCM accuracy standpoint
Act as the standing RCM voice in product planning cycles
Assist with ongoing management of both the Happy provider network and the partner networks, including network status tracking, panel changes, and performance tracking
Flag network gaps tied to geographic expansion or payer contracting priorities
Step in to update credentialing documents, CAQH profiles, and payer applications when the credentialing workload requires backup
Help maintain credentialing SOPs and checklists
Assist with multi-state corporate compliance work, including foreign qualification filings, annual reports, registered agent coordination, and entity maintenance across the PC/MSO structure
Support BAA, MSA, and vendor agreement reviews as a second set of eyes
Track regulatory changes affecting telehealth, DME/OAT billing, and dental-in-medical-network billing
Build ad hoc reports and pivot tables on VOB throughput, claims performance, credentialing status, and network composition
Translate operational data into recommendations for leadership
Qualifications
6+ years of healthcare RCM experience, with demonstrated ownership across VOB, claims, and/or credentialing
Experience working at a startup
Working knowledge of medical billing for DME, dental-in-medical, or specialty telehealth (OAT experience 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/Google Sheets skills — pivot tables, lookups, and reporting are everyday tools
Demonstrated ability to document processes and build SOPs from scratch
Comfort operating in a high-autonomy, high-ambiguity environment
Experience with E0486 and K1027 billing specifically
Familiarity with PC/MSO structures and multi-state corporate compliance
Exposure to credentialing in medical networks (CAQH, PECOS, payer-specific applications)
Experience with clearinghouses and EMRs such as Candid, Healthie, Canvas, or Athena
Prior work with vendors like Candid, Stedi, Healthie, or similar eligibility/e-prescribing platforms
AU, CA + 4 more