Bill Review Specialist - Worker's Compensation

Paradigm Corp; Tampa (FL); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Paradigm Corp in Tampa, FL is seeking a Bill Review Specialist to support accurate processing of workers’ compensation medical bills in a hybrid office setting.

You will research billing inquiries, review documentation, and coordinate with providers, clients, and internal teams to ensure payment accuracy and regulatory compliance. Strong attention to detail and excellent communication are essential.

Qualifications

• High School Diploma required; continuing education in insurance, medical coding or accounting preferred.
• At least 2 years in customer service and 2 years in workers’ comp, healthcare, claims, or bill review.
• Familiarity with Worker’s Comp, healthcare billing, and coding schemes such as ICD-9/ICD-10, CPT, U&C.
• Proficient in Word, Excel, and Outlook with strong organizational skills.

Responsibilities

• Research and resolve billing inquiries, payment questions, discrepancies, and outstanding medical bills.
• Communicate with providers, clients, and internal teams by phone and email to obtain information and resolve billing issues.
• Review medical bills, documentation, fee schedule calculations, pricing, payments, and savings for accuracy.
• Enter and process medical bills and related information accurately within bill review systems.
• Support review and resolution of outstanding incurred but not reported (IBNR) medical bills.
• Process and research appeals and reconsiderations, including reviewing claim-related documentation.
• Identify inconsistencies or missing information and coordinate appropriate follow-up.
• Build effective working relationships with hospitals, physicians, PPOs, specialty providers, and ancillary service providers.
• Serve as a billing and payment resource for internal clinical teams.
• Assist with process documentation, reporting, troubleshooting, and continuous improvement initiatives.
• Maintain knowledge of applicable regulatory, contractual, and industry requirements.

Skills

Attention to detail

Analytical thinking

Excellent communication

Customer service

Education

High School Diploma

Continuing education in insurance/medical coding/accounting

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Paradigm is seeking a Bill Review Specialist to work in a hybrid position in the Tampa, FL, office. The Bill Review Specialist supports accurate and timely processing of workers’ compensation medical bills by reviewing billing documentation, researching payment issues, resolving discrepancies, and responding to billing inquiries. This role works closely with internal teams, providers, and clients to resolve issues and ensure billing accuracy and compliance. The ideal candidate is detail-oriented, analytical, comfortable working with medical billing information, and proactive in identifying and resolving inconsistencies.

Key Responsibilities:

• Research and resolve billing inquiries, payment questions, discrepancies, and outstanding medical bills.
• Communicate with providers, clients, and internal teams by phone and email to obtain information and resolve billing issues.
• Review medical bills, documentation, fee schedule calculations, pricing, payments, and savings for accuracy.
• Enter and process medical bills and related information accurately within bill review systems.
• Support review and resolution of outstanding incurred but not reported (IBNR) medical bills.
• Process and research appeals and reconsiderations, including reviewing claim-related documentation.
• Identify inconsistencies or missing information and coordinate appropriate follow-up.
• Build effective working relationships with hospitals, physicians, PPOs, specialty providers, and ancillary service providers.
• Serve as a billing and payment resource for internal clinical teams.
• Assist with process documentation, reporting, troubleshooting, and continuous improvement initiatives.
• Maintain knowledge of applicable regulatory, contractual, and industry requirements.

Qualifications:

• Education: High School Diploma; successful completion of continuing education in insurance, medical terminology/coding, and/or accounting preferred
• Experience: 2 years customer service experience with a minimum of 2 years worker’s comp, healthcare, claims and/or bill review experience.
• Knowledge of Worker’s Comp; Healthcare billing; ICD-9/ICD-10; CPT; RVS; U&C; Fee Schedule; HCPCS and other coding schemes preferred
• Intermediate computer experience using Microsoft Word, Excel and Outlook required
• Excellent organizational skills
• Language Skills: Excellent oral communication skills and phone presence. Ability to effectively present information to providers as well as to employees of the organization
• Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret a variety of instructions and deal with abstract and concrete variables
• Any combination of education, experience and knowledge that demonstrate the ability to perform the functions of the position will be accepted.