Paradigm is seeking a full-time, remote Medical Bill Analyst Lead for our Complex Claims department. The Medical Bill Analyst Lead performs advanced medical bill review and adjudication while providing day-to-day guidance, technical support, and subject-matter expertise to the Medical Bill Processor and Medical Bill Analyst teams. This role supports management in maintaining the highest standards of accuracy, compliance, productivity, and customer service, and assists with training, quality initiatives, audits, and complex or exception bill processing.

DUTIES AND RESPONSIBILITIES:

• Examine, review, and adjudicate medical bills across all provider types, product lines, and lines of business, including complex and exception bill types.
• Apply appropriate repricing methodologies and ensure billing accuracy by monitoring for excessive charges, duplicate billing, and coding errors.
• Serve as a liaison between analysts, processors, and leadership, escalating trends, risks, system issues, and training needs.
• Participate in audits, quality reviews, and special projects; review and resolve billing appeals and initiate recovery or refund actions as needed.
• Provide backup bill review and claims examination support during workload fluctuations and maintain reliable attendance during scheduled work hours.
• Provide coaching, mentoring, and technical guidance on complex bill review, adjudication decisions, and exception handling; support onboarding and ongoing education.

QUALIFICATION REQUIREMENTS:

• Education: High School Diploma or equivalent required. Bachelor’s Degree or equivalent combination of education and experience preferred. Any combination of higher education, certification (CPC, CRC, etc.), experience and/or knowledge that demonstrate the ability to perform the functions of the position will be accepted.
• Experience in worker’s comp and/or in medical claims processing, research, or a related field (Managed Care Organization – Medicaid, Medicare, Commercial). Project management required.
• Intermediate computer experience using Microsoft Word, Excel and Outlook required.
• Excellent organizational skills.
• Knowledge of worker’s comp; healthcare billing; ICD-9 and ICD-10; CPT; RVS; U&C; fee schedule; HCPCS and other coding schemes preferred.
• Language Skills: Excellent oral communication skills and phone presence. Ability to effectively tailor complex information for diverse audiences, including providers and executive leadership.
• Reasoning Ability: Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment.