Bill Review Process Analyst
About The Position
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. We are seeking a full-time, remote Bill Review Process Analyst. The Bill Review Process Analyst is responsible for analyzing Bill Review operational processes to identify and implement changes to improve performance on key performance indicators including productivity, reliability, quality, and efficiency. The schedule for this position is Monday - Friday, 8 AM to 5 PM Central Time. This position may require travel 1-2 times per year.
Requirements
- Bachelor's Degree in appropriate field of study or equivalent work experience
- Knowledge of process assessment and optimization techniques
- Proven working experience in project management and change management environment
- Excellent client-facing and internal technical communication skills
- Excellent written and verbal communication skills
- Solid organizational skills including attention to detail and multitasking skills
- Strong working knowledge of Microsoft Office and Visio
- Highly Preferred: experience working in claims processing systems, ideally in the Workers Compensation industry
Nice To Haves
- Process mapping and documentation: experience with Visio, BPMN
- Data analysis and reporting: experience using Excel, Tableau, Power BI
- Process improvement methodologies such as Lean, Six Sigma
- Bill review process expertise: deep understanding of bill review workflows; ability to translate operational knowledge into process improvements.
- Claims processing and medical billing: claims adjudication, medical billing coding (CPT, ICD-10, HCPCS) and regulatory requirements (work comp, PPOs)
- Healthcare regulations and compliance: experience with HIPAA, HITECH, Medicare/Medicaid
- Vendor management: manage relationships with external vendors and tech partners
- Stakeholder engagement: collaborate with bill review teams, SMEs, and leadership to understand workflows and drive change
Responsibilities
- Identify and resolve data issues for clients and vendors
- Provide system testing and support for data reporting processes
- Document and communicate solutions for system and customer-specific requirements
- Coordinate internal audits and reviews with the Clinical Bill Review team
- Collaborate with Bill Review leaders to implement process and system changes
- Lead and support process improvement initiatives focused on efficiency, quality, and cost savings
- Analyze current processes and metrics to recommend and implement improvements
- Manage re-engineering and strategic projects, including UAT and stakeholder communication
- Assist project and program managers with key initiatives and maintain process documentation
- Develop leadership skills and contribute to team strategy
- Ensure compliance with information security policies and report incidents as required
Benefits
- PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only)
- competitive salaries
- 401(k) matching contributions
- employer-paid life and disability insurance
- flexible spending and commuter accounts
- employer-matched HSA contributions
- paid time off
- personal holiday programs
- one paid day per calendar year for volunteer time
- Learning Excellence at Paradigm (LEAP) program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
