Bill Review Specialist

Location:

Georgia, USA
• Tampa, FL, USA
• Texas, USA
• Florida, USA
• Virginia, USA
• Req #1640

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.

Watch this short video for a brief introduction to Paradigm.

Paradigm is seeking a full-time, remote Bill Review Specialist. The Bill Review Specialist is responsible for or assists in a wide array of bill review related functions, holds accountability within an assigned area for obtaining, reviewing, processing and auditing outstanding medical billing for accuracy and proper payment, as well as intake, tracking, resolution, and communication of billing inquiries/issues. Receive phone and email inquiries from internal stakeholders, providers and/or clients with questions regarding claims.

Have an outstanding attention to detail, question things that do not appear correct and possess a desire to succeed and progress quickly.

DUTIES AND RESPONSIBILITIES:

• Respond to billing inquiries and payment questions from internal teams, providers, and clients via phone, email, and mail.
• Research and resolve issues related to billing discrepancies, pricing accuracy, and outstanding incurred but not reported (IBNR) bills.
• Perform data entry of bills into the bill review system and assist with appeals and reconsiderations.
• Analyze claim documentation, fee schedules, and savings calculations for accuracy.
• Communicate effectively with providers to educate on billing processes and facilitate payment resolution.
• Participate in interdepartmental meetings and support integrated projects.
• Maintain up-to-date knowledge of regulatory, industry, and contractual requirements.
• Ensure compliance with Paradigm's information security policies.

QUALIFICATIONS:

• Education:
  
  High School Diploma; successful completion of continuing education in insurance, medical terminology/coding, and/or accounting preferred
• Experience:
  
  5 years customer service experience with a minimum of 2 years worker's comp, healthcare, claims and/or bill review experience.
• Skills:
  • Proficiency in Microsoft Word, Excel, and Outlook.
  • Strong organizational and analytical skills.
  • Knowledge of workers' comp billing, ICD-9/ICD-10, CPT, HCPCS, RVS, U&C, and fee schedules preferred.
  • Excellent oral communication and phone presence.
  • Ability to interpret instructions, resolve problems, and manage abstract and concrete variables.

• Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer‑paid life and disability insurance, flexible spending and commuter accounts, and employer‑matched HSA contributions.
• Vacation We believe strongly that work‑life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time We want our employees to engage with and give back to their communities in meaningful ways. Full and part‑time employees receive one paid day per calendar year.
• Learning and development One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning…