Paradigm is seeking a full-time, remote Workers' Compensation Medical Bill Review Appeals and Dispute Specialist. This position reviews provider billing/claims 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.

Responsibilities include (but are not limited to):

• Workers’ Compensation Medical Bill Review and Provider Appeals
  Review and process provider appeals and reconsiderations for medical bills/claims associated with Workers' Compensation.
• Legal and State Dispute Support
  Act as the SME when provider billing disputes escalate to state WC boards. Display strong analytical and communications through compilation of end-to-end provider billing history, payment rationale, and regulatory citations to support the Paradigm Legal department in drafting responses and negotiations.
• Medical Billing Standards and Compliance
  Maintain expertise in Workers' compensation fee schedules, medical billing and coding standards (CPT, ICD-10, HCPCS), and payer-side bill review methodologies, while ensuring compliance with all regulatory requirements.
• Trend Analysis and Process Improvement
  Identify patterns in provider disputes, recommend proactive solutions, and share best practices through training and collaboration.
• Cross-Functional Engagement and Documentation
  Represent Medical Bill Review in meetings with Legal, Compliance and Provider Relations. Maintain accurate, audit-ready records for appeals and disputes.

Qualifications:

• Bachelor’s degree preferred.
• National Workers’ Compensation bill review experience required, 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.