Senior Manager, Contracting & Credentialing

Your Opportunity

The Senior Manager of Contracting & Credentialing is a strategic and operational leader responsible for overseeing provider credentialing, provider licensing, payer contracting, and network expansion across multiple states for a growing telehealth sleep medicine organization. This role requires deep expertise in multi-state credentialing, payer enrollment, government programs (Medicare/TriCare), and third-party vendor management, with a strong understanding of reimbursement and compliance.

This role is critical to enabling scalable growth, payer access, and regulatory compliance in a complex, multi-state telehealth environment. The Senior Manager will directly influence provider onboarding speed, payer coverage, revenue integrity and long-term network strategy with direction from the Direction of Managed Care Contracting.

The ideal candidate is CPC-certified, highly organized, data-driven, and experienced in scaling provider networks while maintaining compliance with federal, state, and payer requirements.

What You'll Do

Credentialing & Provider Enrollment

• Lead end-to-end provider credentialing, provider licensing and recredentialing for MDs and NPs, and any additional allied clinicians across multiple states
• Oversee CAQH, PECOS, Medicare, and commercial payer enrollment
• Ensure compliance with state licensure, scope of practice, supervision, and collaborative practice requirements
• Maintain credentialing records, expiration tracking, and audit-ready documentation
• Manage credentialing/licensing timelines to support rapid provider onboarding and market expansion

Payer Contracting & Network Growth

• Lead payer contracting strategy across commercial, Medicare Advantage, and government payers with direction from Director of Managed Care Contracting
• Negotiate and evaluate fee schedules, reimbursement rates, and contract terms
• Support payer expansion strategy aligned with business growth, market demand, and clinical capabilities
• Coordinate contracting for multi-entity, multi-TIN structures
• Partner with leadership to assess network adequacy, access, and financial impact

Government & Regulatory Contracting

• Oversee Medicare enrollment and compliance (PECOS, reassignment, revalidation)
• Support state-specific government program participation
• Ensure adherence to CMS, No Surprises Act, and payer regulatory requirements
• Collaborate with Compliance to mitigate credentialing and contracting risk

Third-Party Vendor Management

• Manage relationships with credentialing and contracting vendors
• Define SLAs, workflows, and performance expectations
• Audit vendor work for accuracy, timeliness, and compliance
• Serve as escalation point for complex credentialing or payer issues

Cross-Functional Leadership

• Partner closely with Compliance, Legal, Finance, Product, Clinical Leadership and Sales/Marketing/Business Development
• Support product and dev teams with credentialing and payer data requirements (APIs, system builds)
• Provide reporting and dashboards on credentialing status, payer growth, and risk areas
• Prepare materials for board, compliance committee, and executive review

What You Bring

• CPC Certification (required)
• 7+ years of experience in provider credentialing, payer contracting, or provider enrollment
• Proven experience with multi-state credentialing and telehealth operations
• Strong knowledge of Medicare/PECOS, commercial payers, and government programs
• Experience managing third-party credentialing and contracting vendors Familiarity with sleep medicine, DME, or specialty care preferred
• Strong understanding of provider reimbursement and fee schedules
• Exceptional organizational, communication, and stakeholder-management skills

What Makes You Stand Out

• Experience in a telehealth or virtual care environment
• Knowledge of AASM, ACHC, or similar accreditation standards
• Experience supporting API-driven or data-centralized credentialing systems
• Exposure to payer analytics, market expansion strategy, or value-based care

About Our Team

At Sunrise Group, we’re tackling real sleep health challenges that affect millions. We keep things clear and simple ✨, value trust and collaboration 🤝, and lead with optimism and compassion 🌞. These values guide everything we do. If you’re looking for the autonomy to take ownership of your work, make an impact, and be part of a team where ideas move fast and everyone has a voice, Sunrise might just be the right fit.

What We Offer

• Meaningful work that directly improves peoples’ lives
• Be part of an international team across the US, France, Belgium
• Annual company offsite
• Comprehensive health benefits (medical, dental, vision)
• FREE One Medical membership
• 401(k) with company match
• 20 days PTO + 10 paid holidays + 80 hours paid sick leave
• Monthly phone and internet stipend

Compensation

$80,000-$90,000 OTE, depending on experience.

We hire humans, not bullet points. Don’t meet every single qualification? That’s okay. We care more about who you are than what’s on your CV. We’re looking for people who are curious, resourceful, and ready to roll up their sleeves — especially if you’re excited about building something new in healthcare. So if you think you could make an impact here, reach out to us.