Medical Bill Processor - Worker's Compensation

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 by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on . These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch this for a brief introduction to Paradigm.

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.

The schedule for this position is Monday - Friday, 8 AM to 5 PM Eastern Time.

Key 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.

Required Education and Experience

• 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.

Preferred Qualifications

• Continuing education or training in insurance, medical terminology, coding, accounting, or a related field.
• Knowledge of:
  • ICD-9 Coding
  • CPT Codes
  • HCPCS
  • Relative Value Scale (RVS)
  • Usual and Customary (UandC) Fee Schedules
  • Other medical coding and reimbursement methodologies

Knowledge, Skills and Abilities

• 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.