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Medical Bill Processor

Company: Paradigm
Location: Walnut Creek
Posted on: November 22, 2021

Job Description:

About ParadigmParadigm is an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. We have been a pioneer in value-based care since 1991, offering deep clinical expertise, high-value specialty networks, behavioral health support, payment integrity solutions, and robust data analytics to generate the very best outcomes for patients, payers, and providers. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.At Paradigm, People Come FirstIt's more than a job. It's a passion. Work at Paradigm, and you'll find deep satisfaction knowing you're making a profound difference in people's lives.Meaningful work: Better outcomes for all isn't just our tagline. It's what guides us to do our best-every day. At Paradigm, you'll find an authentic connection between the work you do and your passion for making a difference in the world.Exceptional people: You'll work alongside smart people who share a commitment to excellence and a dedication to service. We're not here just for a job. We're here to transform lives.Collaborative culture: At Paradigm, a spirit of collaboration and care is evident in everything we do. We promote a culture of inclusivity and value diversity of all kinds including thought, knowledge, and experience. No matter the team, everyone works together toward a common goal to deliver exceptional outcomes.Paradigm BenefitsHealth and wellness: We want our people to be and stay healthy so we offer a wide variety of 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, commuter accounts, paid life insurance, employer HSA, and 401k contributions.Vacation: We believe strongly that work-life balance is good for you and for our company. Our paid time off and floating-holiday programs give you the flexibility you need to live your life to the fullest.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.We are seeking a full-time Medical Bill Processor to work in the Walnut Creek, CA, office with a hybrid schedule. This position holds accountability for accurate and timely processing and payment of considerably difficult bills to include pre-coding, data entry and adjudication of medical bills/claims..

ESSENTIAL RESPONSIBILITIES include the following. Other work-related duties may be assigned.Examines, enters and adjudicates Network Manager (NWM) bills to include: case coding, vendor look-up, data entry, calculating benefits based on provider contract discounts, plans, exclusions;Examines, enters and adjudicates patient reimbursement bills, PCA invoices, prescription bills, and medical bills/claims to include: case coding, vendor look-up, data entry, calculating benefits based on provider contract discounts, rates, plans, exclusions;Monitors itemized billings for excessive charges, duplications, and appropriate medical bills/claims coding;Reviews bills for required information, pends claims if appropriate and maintains follow-up / alert systems, updates files and releases pends when indicated;Adjusts benefit calculation for under/overpayments;Meets or exceeds department contractual and/or industry standards for accuracy and turnaround time;Tracks and reports production, downtime, issues and trends;Corresponds with Business Owners (BO), Network Managers (NWM), Clinical Service Coordinators (CSC), patients & providers;Updates and maintains current Claims policies and procedures manuals.Responsible for complying with Paradigm IT security requirement and policies.May be responsible for special projects. QUALIFICATION REQUIREMENTS: 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 claims or bill review experience. Intermediate computer experience using Microsoft Word, Excel & Outlook required. Typing speed of 60 WPM and 10-key experience. Excellent organizational skills. Knowledge of ICD-9; CPT; RVS; U&C; Fee Schedule; HCPCS & other coding schemes preferred.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.PM19PI153796195

Keywords: Paradigm, Walnut Creek , Medical Bill Processor, Healthcare , Walnut Creek, California

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