Bill Review Specialist - Worker's Compensation in Tampa, Florida at Paradigm

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 fifth year in a row, we’ve been certified by Great Place to Work® and 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.

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Paradigm is seeking a Bill Review Specialist to work in a hybrid position in the Tampa, FL, office. The Bill Review Specialist supports accurate and timely processing of workers’ compensation medical bills by reviewing billing documentation, researching payment issues, resolving discrepancies, and responding to billing inquiries. This role works closely with internal teams, providers, and clients to resolve issues and ensure billing accuracy and compliance. The ideal candidate is detail-oriented, analytical, comfortable working with medical billing information, and proactive in identifying and resolving inconsistencies.

Key Responsibilities:

• Research and resolve billing inquiries, payment questions, discrepancies, and outstanding medical bills.
• Communicate with providers, clients, and internal teams by phone and email to obtain information and resolve billing issues.
• Review medical bills, documentation, fee schedule calculations, pricing, payments, and savings for accuracy.
• Enter and process medical bills and related information accurately within bill review systems.
• Support review and resolution of outstanding incurred but not reported (IBNR) medical bills.
• Process and research appeals and reconsiderations, including reviewing claim-related documentation.
• Identify inconsistencies or missing information and coordinate appropriate follow-up.
• Build effective working relationships with hospitals, physicians, PPOs, specialty providers, and ancillary service providers.
• Serve as a billing and payment resource for internal clinical teams.
• Assist with process documentation, reporting, troubleshooting, and continuous improvement initiatives.
• Maintain knowledge of applicable regulatory, contractual, and industry requirements.

Qualifications:

• Education: High School Diploma; successful completion of continuing education in insurance, medical terminology/coding, and/or accounting preferred
• Experience: 2 years customer service experience with a minimum of 2 years worker’s comp, healthcare, claims and/or bill review experience.
• Knowledge of Worker’s Comp; Healthcare billing; ICD-9/ICD-10; CPT; RVS; U&C; Fee Schedule; HCPCS and other coding schemes preferred
• Intermediate computer experience using Microsoft Word, Excel and Outlook required
• Excellent organizational skills
• Language Skills: Excellent oral communication skills and phone presence. Ability to effectively present information to providers as well as to employees of the organization
• Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret a variety of instructions and deal with abstract and concrete variables
• Any combination of education, experience and knowledge that demonstrate the ability to perform the functions of the position will be accepted.