Job description

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex and catastrophic 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, including its risk-based clinical solutions, case management services, high-value specialty networks, home health, and payment integrity programs. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.

This position holds accountability within an assigned area for obtaining, reviewing, and auditing outstanding medical billing for accuracy and proper payment.

DUTIES AND RESPONSIBILITIES:

• Review outstanding incurred but not reported (IBNR) medical bills.
• Initiate, negotiate and develop relationships with providers, including preferred provider organizations (PPOs), hospitals and specialty providers, ancillary services providers, and physicians.
• Work with internal teams to research and determine nature of IBNR.
• Work with external providers and organizations to review and request outstanding IBNR.
• Immediately process IBNR bills upon receipt to expedite budget process.
• Serve as a resource for Paradigm Clinical Management staff (e.g. IMT, PMT) with injured worker-specific financial liability budget for provider services, including direct negotiation, fee schedule and PPO. Develop and submit LOA as required to secure negotiated rate.
• Maintain current knowledge of regulatory, industry and contractual factors to ensure compliance in all aspects of administration of Paradigm’s provider network.
• Participate as required in Paradigm internal staff development programs.
• Other duties as assigned.

QUALIFICATION REQUIREMENTS:

• Education - Bachelor’s Degree in health care administration, business, finance or a related field from an accredited college or university or equivalent experience and education which demonstrates the ability to perform the functions of the position.
• Experience – A minimum or combination of five years of experience with demonstrated success in Medical Billing and financial negotiations.
• Must maintain current understanding of state regulations and their impact on medical care and reimbursement in the workers’ compensation care market.
• Language Skills - Excellent oral and written communication skills; able to make presentations to audiences of varying levels, size, nature and backgrounds.
• Reasoning Ability - Demonstrated ability to analyze difficult situations, problems and data and develop feasible and effective solutions. Demonstrated ability to implement and monitor project responsibilities.
• Any combination of education, experience and knowledge that demonstrate the ability to perform the functions of the position will be accepted.

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.

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