Senior Manager, RCM & Compliance 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. 

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

Verification of Benefits - Process Structure & Execution

• 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

Claims Operations Support

• 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

Product Partnership - RCM Systems Integration

• 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

Network Management - Happy & Partner Network

• 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

Credentialing Support

• Step in to update credentialing documents, CAQH profiles, and payer applications when the credentialing workload requires backup

• Help maintain credentialing SOPs and checklists

Compliance & Corporate Filings

• 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

Reporting & Analysis

• 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

Required:

• 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

Preferred:

• 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