Medical Bill Processor - Worker's Compensation
About The Position
Paradigm is seeking a detail-oriented Medical Bill Processor to join our Bill Review team. This role is responsible for the accurate and timely processing, adjudication, and payment of medical and non-medical bills and claims. The Medical Bill Processor ensures compliance with client guidelines, contractual requirements, and industry standards while delivering exceptional service to providers, injured workers, clients, and internal stakeholders. At Paradigm, we are committed to a customer-first approach. By leveraging our expertise, technology, and collaborative culture, we strive to achieve the best possible outcomes for injured workers, payors, providers, and clients.
Requirements
- High school diploma or equivalent.
- Minimum of 2 years of customer service experience.
- Minimum of 2 years of claims processing, bill review, medical billing, or related experience.
- Intermediate proficiency with Microsoft Word, Excel, and Outlook.
- Typing speed of at least 60 words per minute.
- 10-key data entry experience.
Nice To Haves
- Continuing education or training in insurance, medical terminology, coding, accounting, or a related field.
- Knowledge of ICD-9 Coding
- Knowledge of CPT Codes
- Knowledge of HCPCS
- Knowledge of Relative Value Scale (RVS)
- Knowledge of Usual and Customary (UandC) Fee Schedules
- Knowledge of Other medical coding and reimbursement methodologies
- Strong attention to detail and accuracy.
- Excellent organizational and time-management skills.
- Effective verbal and written communication skills.
- Professional phone presence and customer service orientation.
- Ability to explain information clearly to providers, clients, and internal teams.
- Strong analytical and problem-solving skills.
- Ability to collect and evaluate data, interpret guidelines, and make sound decisions.
- Ability to manage multiple priorities in a fast-paced environment while maintaining quality standards.
Responsibilities
- Review, enter, and adjudicate Network Manager (NWM) bills, including case coding, vendor lookup, data entry, and benefit calculations based on provider contract discounts, plans, and exclusions.
- Process patient reimbursement bills, PCA invoices, prescription bills, and medical claims accurately and efficiently.
- Review and adjudicate injured worker reimbursement forms, ensuring proper documentation and timely payment.
- Research and resolve keying exceptions by reviewing bill images and accurately entering information into the bill review system.
- Enter and process non-medical bills for payment.
- Forward medical bills and claims that fall outside Paradigm contract dates to the appropriate carrier.
- Gather Explanation of Review (EOR) documents and supporting claim documentation for jurisdiction-specific requirements and submit to carriers as needed.
- Meet or exceed established productivity, accuracy, and turnaround time standards.
- Track and report production metrics, downtime, issues, and trends.
- Communicate professionally with Business Owners, Network Managers, Clinical Service Associates, providers, patients, and other stakeholders.
- Support departmental administrative functions and special projects as assigned.
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 volunteer day per calendar year.
- Learning Excellence at Paradigm (LEAP) program.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
