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.

Job Title: Network Services Associate
SUMMARY:

The Network Services Associate will handle data entry, analyze data sets, handle incoming Provider Calls and emails and process reconsiderations. It is imperative that the Network Services Associate possess exemplary customer service skills, have a demonstrated ability to work independently, and function effectively as a member of the Network Services team.

DUTIES AND RESPONSIBILITIES:

• Answer in-coming calls during business hours and reply to phone messages left overnight when the phones are not staffed
• Respond to email bill inquiries and disputes from providers, clients and internal customers.  Treat all customers, internal and external, in a courteous and cooperative manner by providing exceptional customer service to internal and external customers
• Understand and comply with all HIPAA & SOC2 requirements necessary in working with designated PHI
• Document and update information in cases and D365 with high degree of accuracy.
• Must utilize critical thinking skills while handling billing issues.
• Assist with training with team members and new staff as needed
• Process reconsiderations per client specific procedures
• Perform additional duties as identified and directed by management
• Responsible for complying with Paradigm IT security requirement and policies
• Responsible for safeguarding Paradigm or Paradigm related IT passwords
• Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management

QUALIFICATION REQUIREMENTS:  To perform this job successfully an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• College education preferred with a minimum of two years in a clerical setting (preferably healthcare).
• Prefer either workers’ compensation or call center experience.
• Excellent communication skills both written and verbal,
• Acute attention to detail Proficient in all Microsoft Office and computer application systems
• Ability to express ideas clearly, concisely, and effectively, verbally and in writing.
• Working knowledge and working experience with CPT, ICD10, MS-DRG, LTC-DRG, CMG, PDPM, HHRG bill coding systems, UB and HCFA claim forms and correct data field entries for all fields on both standard billing documents, medical terminology, and billing regulations
• Ability to work independently
• Medical office or insurance experience a plus. 
• Bilingual (English/Spanish) a plus.

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.