Paradigm is seeking a full-time, remote Provider Appeals and Legal Liaison. The Provider Appeals and Legal Liaison is responsible for leading the interface between the Medical Bill Review/Claims team and Paradigm’s Legal department. This position manages complex medical provider appeals and reconsiderations, supports legal responses to medical billing disputes, and ensures compliance with Workers’ Compensation regulations and best practices. The ideal candidate brings deep subject matter expertise, advanced analytical capabilities, and exceptional communication skills to drive resolution and influence cross-functional collaboration.

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

Responsibilities include (but are not limited to):

• Provider Dispute Resolution
  • Serve as the main liaison between Medical Bill Review, Complex Claims, and Legal for repricing disputes, appeals, and regulatory filings
  • Lead resolution efforts for complex provider appeals and billing reconsiderations
• Legal Collaboration and Documentation
  • Draft and refine clear, defensible responses to providers and legal teams
  • Review legal documents and escalate or seek guidance as needed
• Expertise in Billing Standards
  • Maintain deep knowledge of Workers’ Compensation fee schedules, coding standards, and bill review methodologies
• Trend Analysis and Process Improvement
  • Identify patterns in provider disputes and recommend proactive solutions
  • Support internal training and share best practices across teams
• Cross-Functional Engagement and Recordkeeping
  • Represent Medical Bill Review in meetings with Compliance, Provider Relations, and Network Development
  • Ensure accurate documentation and maintain audit-ready records

Qualifications:

• Bachelor’s degree or equivalent experience required; advanced coursework in healthcare administration, legal studies, or medical billing preferred.
• Minimum 7 years of national Workers’ Compensation bill review experience, with at least 3 years in a role involving appeals, reconsiderations, or legal coordination.
• Excellent written and oral communication skills and phone presence. Ability to effectively present information to providers as well as to employees of the organization
• Advanced understanding of medical billing, coding (ICD-10, CPT, HCPCS), and Workers’ Compensation regulations.
• Strong analytical and critical thinking abilities.
• Proven ability to collaborate effectively with legal, compliance, and operational teams.
• Proficiency in Microsoft Office and bill review platforms.
• Detail-oriented with excellent organizational and time management skills.