Network Services AssociateParadigm

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.

The Network Services Associate will handle data entry, analyze data sets, handle incoming Provider bill status emails, and process reconsiderations, disputes, and state disputes. It is imperative that the Network Services Associate possess exemplary customer service skills, have a demonstrated ability to work independently, and function effectively as a member of the Network Services team.

DUTIES AND RESPONSIBILITIES:

• Respond to email bill inquiries and disputes from providers, clients and internal customers.
• Work with Finance, Provider Management, and external network partners to resolve provider disputes and questions.
• Work with clients to resolve pricing issues and state disputes within regulatory timeframes.
• Treat all customers, internal and external, in a courteous and cooperative manner by providing exceptional customer service to internal and external customers
• Understand and comply with all HIPAA & SOC2 requirements necessary in working with designated PHI
• Document and update information in cases and billing systems with high degree of accuracy.
• Must utilize critical thinking skills while handling billing issues.
• Assist with training with team members and new staff as needed
• Process reconsiderations per client specific procedures
• Perform additional duties as identified and directed by management
• Maintain reliable and predictable attendance during scheduled work hours

QUALIFICATION REQUIREMENTS:

• College education preferred with a minimum of two years in a clerical setting (preferably healthcare).
• Prefer either workers’ compensation or call center experience.
• Excellent communication skills both written and verbal,

• Acute attention to detail Proficient in all Microsoft Office and computer application systems
• Ability to express ideas clearly, concisely, and effectively, verbally and in writing.
• Working knowledge and working experience with CPT, ICD10, MS-DRG, LTC-DRG, CMG, PDPM, HHRG bill coding systems, UB and HCFA claim forms and correct data field entries for all fields on both standard billing documents, medical terminology, and billing regulations
• Ability to work independently
• Medical office or insurance experience a plus.
• Bilingual (English/Spanish) a plus.