Medical Bill Analyst at Paradigm – Tampa, Florida

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 hiring a full-time, remote Bill Review Analyst. This position holds accountability for accurate and timely review, processing and payment of bills to include pre-coding accuracy and adjudication of medical bills.

DUTIES AND RESPONSIBILITIES:

• Examines and adjudicates bills for all provider types, product lines, bill types and lines of business from start to finish
• Evaluates medical documentation, diagnosis codes, and treatment context to determine relatedness of services to a compensable injury.
• Maintains knowledge of industry standard medical coding initiatives and state specific fee schedules and coding guidelines such as Medicare reimbursement methodology, NCCI edits, MUEs, Level of Service reviews and outlier charges
• Meets or exceeds department contractual and/or industry standards for accuracy and turnaround time
• Maintains an understanding of all variations of Workers’ Compensation State rules and regulations with the ability to navigate and interpret various types of fee schedules
• Maintains comprehensive knowledge of all available non-fee schedule re-pricing opportunities (e.g. PPOs, direct contracts, Fair Market Pricing etc.) and ensures application as part of the adjudication process
• Monitors itemized billings for excessive charges, duplications, and appropriate medical bills coding
• Reviews/processes appeals
• Initiates refund requests and assists in the recoupment process as needed
• Assists in Contract Recoveries, as needed
• Assists in the preparation of bills research reports
• Provides customer service to render efficient customer satisfaction, including timely response and resolution to customer issues, complaints, questions and requests

QUALIFICATION REQUIREMENTS:

• Education - AA Degree or equivalent bill review experience
• Experience – 3+ years of medical coding or bill review experience
• Intermediate computer experience using MS Word, MS Excel & Outlook required
• Typing speed of 60 WPM on data entry
• Excellent organizational skills
• Knowledge of ICD-10; CPT; Revenue Code; RVS; U&C; Fee Schedule; RBRVS; DRG; HCPCS & other coding schemes
• 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