Network Billing Associate

Location:

Tampa, FL, USA

Req Number:
Req #1549

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.

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.

This position requires reporting to the Tampa office for the first 90 days for onboarding and training. After this initial period, the role transitions to a hybrid schedule, offering a blend of in-office and remote work.

• 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 facility 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 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

• 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
• Acute attention to detail
• Proficient in all Microsoft Office and computer application systems

• Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives Paradigm s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life…