Network Billing Associate

Position Overview

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. With a pioneering track record since 1991 and recognized as one of Fortune’s Best Workplaces in Health Care™, our deep clinical expertise underpins risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. The Network Billing Associate will be responsible for the intake, repricing, and processing of all network bills in compliance with established standards. This role begins with a 90‑day onboarding period at the Tampa office and then transitions to a hybrid schedule offering a blend of in‑office and remote work.

Key Responsibilities

• Manage the day-to-day billing activities
• Ensure contractual and statutory billing compliance
• Review and comprehend documentation, fee schedule calculations, and savings output to clients with the ability to identify inconsistencies
• Prepare and analyze billing for various facilities using appropriate coding and utilizing State Statutes
• Process appeals and reconsiderations
• Document/update information in cases with a high degree of accuracy
• Comply with and adhere to all regulatory compliance areas, policies, procedures, and best practices
• Understand and comply with all HIPAA & SOC2 requirements necessary when working with designated PHI
• Provide exceptional customer service to internal and external customers
• Perform additional support functions as needed
• Comply with Paradigm IT security requirements and policies
• Safeguard Paradigm or Paradigm-related IT passwords
• Notify Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management

Required Qualifications

• Strong experience in medical insurance/healthcare billing in a medical clinic, healthcare system, institutional post‑acute care provider, or medical practice covering workers' compensation, commercial insurance, CMS‑Medicare, and state Medicaid payor types
• Proven skills in creating institutional provider billing from primary source charge data for Skilled Nursing Facilities, Long Term Acute Care Hospitals, Inpatient Rehabilitation Hospitals, and Home Health Services in both commercial and CMS‑Medicare billing environments
• Thorough knowledge of CPT, ICD10, MS‑DRG, LTC‑DRG, CMG, PDPM, HHRG bill coding systems, UB and HCFA claim forms, proper data field entries, medical terminology, and billing regulations
• Prior experience with healthcare provider billing software and billing coding resource databases
• Excellent written and verbal communication skills along with strong interpersonal abilities
• Ability to work independently with acute attention to detail
• Proficiency in all Microsoft Office and related computer application systems

Benefits & Perks

• Health and wellness – PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only)
• Financial incentives – Competitive salaries, 401(k) matching contributions, employer‑paid life and disability insurance, flexible spending and commuter accounts, and employer‑matched HSA contributions
• Vacation – Paid time off and personal holiday programs to support work‑life balance
• Volunteer time – One paid day per calendar year to engage with and give back to the community
• Learning and development – Opportunities for continuous learning through programs like Learning Excellence at Paradigm (LEAP)