Network Billing Associate

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.

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.

SUMMARY: The Network Billing Associate is responsible for the intake, repricing, and processing of all network bills adhering to established standards and practices. Identify Provider documents and claim demographics to prepare a complete and accurate record for review. Assist with email inquiries from providers and/or clients with questions regarding claims. Have an outstanding attention to detail and possess a desire to succeed and progress quickly.

DUTIES AND RESPONSIBILITIES:

• Manage the day-to-day billing activities
• Ensure contractual and statutory billing compliance
• Review and comprehend documentation, fee schedule calculations, and savings output to clients with the ability to identify inconsistencies
• Prepare and analyze billing for various facilities using appropriate coding and utilizing State Statutes
• Process appeals and reconsiderations
• Document/update information in cases with high degree of accuracy
• Complies with and adheres to all regulatory compliance areas, policies, and procedures and best practices
• Understand and comply with all HIPAA & SOC2 requirements necessary in working with designated PHI
• Provide exceptional customer service to internal and external customers
• Perform additional support functions as needed
• Responsible for complying with Paradigm IT security requirements and policies
• Responsible for safeguarding Paradigm or Paradigm-related IT passwords
• Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong experience of medical insurance/healthcare billing in a medical clinic and/or healthcare system, institutional post-acute care provider or medical practice including workers’ compensation, commercial insurance, CMS-Medicare, and state Medicaid payor types
• Effective skills in creating institutional provider billing from primary source charge data for Skilled Nursing Facilities, Long Term Acute Care Hospitals, Inpatient Rehabilitation Hospitals, Home Health Services in both commercial insurance and CMS-Medicare billing environments
• Thorough knowledge and working experience with CPT, ICD
  10, MS-DRG, LTC-DRG, CMG, PDPM, HHRG bill coding systems, UB and HCFA claim forms and correct data field entries for all fields on both standard billing documents, medical terminology, and billing regulations
• Prior experience interacting with healthcare provider billing software and healthcare billing coding resource databases
• Excellent communication skills both written and verbal, and internal personal skills
• Ability to work independently
• Proficient in all Microsoft Office and computer application systems

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical
  
  Activities:
  
  While performing the duties of this job, the employee is regularly required to reach with hands and arms, and to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand and walk
• Weight…