Bill Review Specialist - Worker's Compensation

Paradigm•Tampa, FL

3d•Hybrid

About The Position

Paradigm is seeking a Bill Review Specialist for a hybrid position in its Tampa, Florida office. The role supports accurate and timely processing of workers’ compensation medical bills through review of billing documentation, research into payment issues, discrepancy resolution, and responses to billing inquiries. The specialist works with internal teams, providers, and clients to resolve issues and ensure billing accuracy and compliance. The ideal candidate is detail-oriented and analytical, comfortable working with medical billing information, and proactive in identifying and resolving inconsistencies.

Requirements

High school diploma.
At least 2 years of customer service experience.
At least 2 years of workers’ compensation, healthcare, claims, and/or bill review experience.
Intermediate computer experience using Microsoft Word, Excel, and Outlook.
Excellent organizational skills.
Excellent oral communication skills and phone presence.
Ability to effectively present information to providers and organization employees.
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 demonstrating the ability to perform the position’s functions will be accepted.

Nice To Haves

Successful completion of continuing education in insurance, medical terminology/coding, and/or accounting.
Knowledge of workers’ compensation and healthcare billing.
Knowledge of ICD-9/ICD-10, CPT, RVS, U&C, fee schedules, HCPCS, and other coding schemes.

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 the 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.