Billing Implementation Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee the complete billing implementation process for new payer and health plan launches, from kickoff to billing readiness and going live.

• Navigate payers through Color's established billing implementation protocol, which includes implementation meetings, billing configuration, claims testing, and key milestones.

• Monitor the progress of implementations, coordinate subsequent steps, engage with stakeholders, and escalate any risks or barriers.

• Recognize potential risks and create strategies for mitigation.

• Act as the main point of contact for daily billing implementation activities.

• Foster relationships with payer billing representatives while collaborating with Customer Success Managers.

• Address implementation inquiries, lead meetings, and troubleshoot issues with payer billing representatives.

• Monitor billing KPIs such as first-pass claim acceptance, denial rates, and payment turnaround times.

• Set up billing integrations via major payer networks like Cigna, Anthem, and UnitedHealthcare through EDI or API pathways.

• Resolve billing data or eligibility challenges in collaboration with billing partners, engineering, and client success teams.

• Create and uphold standard operating procedures to ensure consistent and compliant billing practices.

• Investigate and address issues related to payer setup, claims processing, billing readiness, and claims denials.

• Maintain documentation, trackers, and SOPs for implementations.

• Analyze billing workflows to identify opportunities for improvement, automation, and process optimization.

⛳️ Requirements

• A minimum of 5 years of experience in revenue cycle management, payer relations, billing operations, or customer implementation.

• Previous experience with health plans, TPAs, provider organizations, or healthcare billing is essential.

• Strong preference for candidates with experience managing implementations with ASOs/TPAs or health plan partnerships.

• Exceptional organizational and project management abilities.

• Outstanding communication, stakeholder management, and cross-functional coordination skills.

• Capability to manage multiple implementations at once.

• Comfortable facilitating meetings with external partners.

• Strong follow-up skills and stakeholder management capabilities.

• Ability to independently advance work and resolve conflicts.

• Familiarity with CPT/HCPCS codes, payer credentialing, and claim lifecycle management.

• Proficient in configuring billing integrations through EDI or API pathways.

• Validate member eligibility and ensure correct payer setup for claim adjudication.

• Must possess the unrestricted right to work in the United States for any employer.

🏝️ Benefits

• Comprehensive medical, dental, vision, life, and disability coverage.

• 401k matching program.

• Monthly stipends for phone and wifi expenses for employees.

• Annual ergonomic equipment stipend.

• Generous vacation policy.

• Paid holidays.

• Company-wide recharge days.

• Equal paid parental leave for both birthing and non-birthing parents.

• Complimentary cancer screening and prevention resources for employees and their adult dependents.

• Possible eligibility for equity and additional benefits.