Network Services Associate

Paradigm; Tampa (FL); On-site; USD 38,000 - 48,000; Full time

Job summary

Paradigm is a leading healthcare management organization focused on improving outcomes for patients with complex conditions. The Network Services Associate role emphasizes data entry, data analysis, and handling provider inquiries with strong customer service.

Ideal candidates will have two years of clerical healthcare experience, excel in Microsoft Office, and be comfortable with CPT/ICD10 billing terminology.

Qualifications

• College education preferred with a minimum of two years in a clerical setting, preferably healthcare.
• Experience in workers' compensation or call center is a plus.
• Strong written and verbal communication and attention to detail.
• Proficient with CPT, ICD10, MS-DRG, CMG, PDPM, and billing forms.

Responsibilities

• Respond to email bill inquiries and disputes from providers, clients and internal customers.
• Work with Finance, Provider Management, and external network partners to resolve provider disputes and questions.
• Resolve pricing issues and state disputes within regulatory timeframes.
• Document information in cases and billing systems with high accuracy.
• Utilize critical thinking to address billing issues and assist training as needed.
• Maintain dependable attendance during scheduled hours.

Skills

Excellent communication

Attention to detail

Microsoft Office proficiency

Bilingual English/Spanish a plus

Independent worker

Education

College education preferred

Tools

Microsoft Office

Billing systems

CPT/HCFA knowledge

Job description

Req Number: Req #2000

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex 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: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch this short video for a brief introduction to Paradigm.

The Network Services Associate will handle data entry, analyze data sets, handle incoming Provider bill status emails, and process reconsiderations, disputes, and state disputes. 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:

• Respond to email bill inquiries and disputes from providers, clients and internal customers.
• Work with Finance, Provider Management, and external network partners to resolve provider disputes and questions.
• Work with clients to resolve pricing issues and state disputes within regulatory timeframes.
• 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 billing systems 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
• Maintain reliable and predictable attendance during scheduled work hours

QUALIFICATION REQUIREMENTS:

• 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.

Other details

PI288237548