Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex and catastrophic 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, including its risk-based clinical solutions, case management services, high-value specialty networks, home health, and payment integrity programs. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.

 
The Network Billing Customer Service Associate is responsible for taking inbound calls from health care providers or clients regarding claims as well communicating directly with billing and finance departments for outstanding action.  Have an outstanding attention to detail and possess a desire to succeed.

Hybrid: This role requires orientation in the office for up to 90 days 

DUTIES AND RESPONSIBILITIES:

• Answer all inbound calls from providers and clients
• Meet department standards for productivity, including number of calls handled per day and week, percentage of time spent in the queue or on calls, percentage of rejected calls, average hold and average handling times.  Ensure contractual and statutory billing compliance
• Review, comprehend and communicate details regarding claims status including but not limited to payment details, sent for bill review etc…
• Document/update information in cases with high degree of accuracy
• Escalate advanced issues when appropriate
• Provide exceptional customer service to internal and external customers
• As a team member, continually support the team’s efforts to provide exceptional service by identifying ideas for improvement in documentation and/or approach 
• Complies with and adheres to all regulatory compliance areas, policies and procedures and best practices
• Understand and comply with all HIPAA & SOC2 requirements necessary in working with designated PHI

QUALIFICATION REQUIREMENTS:  

• At least 1 year of customer service experience in a medical/healthcare setting. 
• Medical terminology
• Excellent communication skills both written and verbal, and internal personal skills
• Ability to work independently
• Acute attention to detail
• Proficient in all Microsoft Office and computer application systems
• Medical billing in workers compensation industry preferred but not required

PM19

Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in, and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.