Payment Specialist

Payment Specialist

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

We're proud to be recognized—again! For the fourth year in a row, we've been certified by Great Place to Work®, and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

The Payment Specialist is responsible for managing the end-to-end payment process, ensuring accuracy, compliance, and timely disbursement of funds to external vendors and providers. This role exercises independent judgment in resolving complex payment issues, performs advanced analysis of payment trends, and leads process improvement initiatives. The Payment Specialist serves as a subject matter expert (SME) and key liaison across internal teams and external partners to enhance operational efficiency and payment accuracy.

• Prepare, audit, and generate complex payment files for submission to payment vendors in accordance with established schedules, client requirements, and regulatory guidelines
• Validate payment file accuracy through detailed review of payment data, provider information, offsets, adjustments, and reconciliation balancing
• Submit payment files through designated vendor platforms and ensure successful transmission, receipt, and processing
• Monitor payment submissions for rejections, exceptions, or error notifications and take immediate corrective action to prevent payment delays
• Perform detailed reconciliations between vendor platforms, internal systems, bank reporting, and payment batches to ensure financial accuracy and completeness
• Research, analyze, troubleshoot, and resolve payment file discrepancies, balancing issues, and processing errors in a timely manner
• Serve as a subject matter resource and liaison for provider payment release requests, escalated inquiries, and payment status investigations
• Process payment reissue, void, stop payment, recoupment, and offset requests in accordance with department procedures and compliance standards
• Create and validate client refund files for Accounting department processing and reconciliation
• Collaborate cross functionally with internal departments, external vendors, banking partners, and IT resources to resolve discrepancies, transmission failures, and file format issues
• Maintain detailed documentation and audit ready records of payment submissions, corrections, reconciliations, approvals, and outcomes
• Analyze payment activity trends and provide reporting related to payment accuracy, aging, rejection trends, reconciliation findings, and resolution timelines
• Identify operational risks, process inefficiencies, and recurring payment issues and recommend process improvements to enhance accuracy, reduce rework, and improve turnaround times
• Support revenue cycle operations through accurate and timely disbursement processing while ensuring adherence to client contractual obligations and departmental service levels
• Generate, analyze, and reconcile reports from Data Warehouse and applicable systems to identify Provider Accounts Payable due and outstanding payment activity
• Reconcile Jopari payment acknowledgement reports against payment batch files to identify invoices requiring voids, corrections, or internal reprocessing
• Generate Explanation of Reimbursement (EOR) documentation and coordinate distribution processes
• Manage and prioritize the AP queue for provider payment requests, escalations, research items, and inquiries while maintaining service expectations
• Generate and review outstanding AP reports with Manager, Revenue Management and assist…