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.

• This position is hybrid and will work from the Tampa office 2-3 days per week (the remaining days will be work from home).
• Schedule for this position is Monday - Friday from 8 AM to 5 PM Eastern time. Variation from this schedule may be possible and will be discussed at time of interview.

• Coding experience, with strong preference for candidates who have experience with worker's compensation, Medicare / Medicaid, on the payer side.
• Coding certified required, with AAPC preferred.
• Intermediate computer experience using an MS Word, MS Excel & Outlook required.
• Knowledge of CPT and HCPCS.
• Experience with SmartAdvisor strongly preferred.

The Bill Review Analyst duties include, but are not limited to:

• Monitor itemized billings for excessive charges, duplications, and appropriate medical bills coding.
• Review bills for required information, pend bills if appropriate and maintain follow-up / alert systems, update files and release pends when indicated. Adjust benefit calculation for under- and over-payments.
• Examine, enter and adjudicate bills for all provider types, product lines, bill types and lines of business. Maintain comprehensive knowledge of all available re-pricing opportunities (e.g. PPOs, direct contracts, etc.), ensure application as part of the adjudication process.
• Maintain an understanding of all variations of Workers' Compensation state rules and regulations.
• Meet or exceed department contractual and/or industry standards for accuracy and turnaround time.
• Review / process appeals and initiates refund requests, assist in the recoupment process.
• Assist in the preparation of bills research reports.
• Provide customer service to render efficient customer satisfaction, including timely response and resolution to customer issues, complaints, questions and requests.

What do we offer?

• Health and wellness: We want our people to be and stay healthy, so we offer a wide variety of value-added HMO, PPO, and HDHP health insurance options with both Cigna and Kaiser Health.
• Financial incentives: Paradigm's financial benefits also help prepare you for the future: competitive salaries, flexible spending, paid life insurance, employer HSA, and 401(k) with company match.
• Vacation: We believe strongly that work-life balance is good for you and for our company. We offer paid time off, paid holidays and a floating holiday.
• Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow.

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.

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.

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