Location: Req Number: Req #1095 Date Posted: Tuesday, July 2, 2024
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.
Job Title: Medical Bill Processor
SUMMARY: This position holds accountability for accurate and timely processing and payment of considerably difficult bills to include pre-coding, data entry and adjudication of medical bills/claims.
DUTIES AND RESPONSIBILITIES:
Examines, enters and adjudicates Network Manager (NWM) bills to include: case coding, vendor look-up, data entry, calculating benefits based on provider contract discounts, plans, exclusions;
Examines, enters and adjudicates patient reimbursement bills, PCA invoices, prescription bills, and medical bills/claims to include: case coding, vendor look-up, data entry, calculating benefits based on provider contract discounts, rates, plans, exclusions;
Monitors itemized billings for excessive charges, duplications, and appropriate medical bills/claims coding;
Reviews bills for required information, pends claims if appropriate and maintains follow-up / alert systems, updates files and releases pends when indicated;
Adjusts benefit calculation for under/overpayments;
Meets or exceeds department contractual and/or industry standards for accuracy and turnaround time;
Tracks and reports production, downtime, issues and trends;
Corresponds with Business Owners (BO), Network Managers (NWM), Clinical Service Coordinators (CSC), patients & providers;
Updates and maintains current Claims policies and procedures manuals.
Responsible for complying with Paradigm IT security requirement 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
May be responsible for special projects.
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.
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 claims or bill review experience. Intermediate computer experience using Microsoft Word, Excel & Outlook required. Typing speed of 60 WPM and 10-key experience. Excellent organizational skills. Knowledge of ICD-9; CPT; RVS; U&C; Fee Schedule; HCPCS & other coding schemes preferred.
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.
Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Other details
Job Family Active Pay Type Hourly Min Hiring Rate $20.00 Max Hiring Rate $24.47
