Bill Review Specialist - Worker's Compensation

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. Watch this short video for a brief introduction to Paradigm.

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.

Paradigm Benefits: 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 and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.

Vacation

• We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest. Volunteer time – We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program. 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. Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at [email protected] . 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. As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster #LI-Hybrid