Location: Tampa, FL, USA
Req Number: Req #1486
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.
Paradigm is seeking a full-time Complex Billing Manager of Operations for our Tampa, FL, office.
The Manager of Operations is a strategic thinker with daily operational oversight of operational functions that support Paradigm’s Complex Claims and Medical Bill Review function. This roles manages and oversees a dynamic team of both hybrid and remote employees responsible for execution of a variety of specialty and ancillary support functions, as well as ensuring compliance in medical bill review, provider and client reimbursement, and stakeholder issue resolution. A focus on productivity and operations excellence, strategic thought, leadership, and management of cross-functional complex issue resolution is a key to success in this role.

DUTIES AND RESPONSIBILITIES:

• Team and Functional Oversight
• Accountable for performance and leadership of team members handling:
• Stakeholder issue resolution, bill inquiries, and customer service support
• Provider and/or group health engagement to secure unsubmitted bills
• Recovery of overpayments to providers
• Provider reconsideration requests, overpayments and underpayment resolution, and internal pricing resolution
• Coordination with Legal on escalated medical payment appeals, state disputes, and liens
• Reimbursements to clients/carriers for incorrectly paid bills
• Execution of specialty repricing partnerships
• Client, State, NCCI, EDI, and miscellaneous regulatory reporting
• External vendor or contracted staff supporting any of the above mentioned functions
• Foster a team culture dedicated to collaboration, continuous education, forward-thinking, productivity, and overall excellence
• Develop team members and support professional development and growth for continued career development
• Maintain confidentiality and integrity of PHI in line with HIPAA and internal Privacy and Information Security policies.
• Operations and Coordination
• Be a thought leader and subject matter expert in inter-departmental and cross-functional collaboration for performance improvement, process enhancements, and/or resolution
• Develop, enhance, and execute on process improvement opportunities through ongoing assessment, documentation of SOPs/Process Documentation, and/or coordination with training department team members
• Performance and Strategy
• Track and analyze team trends to identify and execute on performance improvement opportunities
• Propose and support the development and execution of strategic plans to enhance operational effectiveness and cost efficiency
• Strong focus on developing and enhancing performance measurement, with development and execution of productivity/SLA/KPI monitoring, communication, and accountability

SUPERVISORY RESPONSIBILITIES:

• Interview, mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback.
• Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.
• Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.

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.

• Bachelor’s Degree in Business, Healthcare, and/or a related field
• Minimum of 3-5+ years in bill review/claims operations management, healthcare management, worker’s comp, and/or a related area
• Proven experience in team leadership, commitment to team development and culture, and dedication to process optimization
• Strong analytical, decision-making, and communication skills
• Ability to maintain a positive team culture in a hybrid environment.
• Strong experience with medical insurance/healthcare billing practices in a healthcare system or medical practice, preferably in workers’ compensation.
• Thorough understanding of network practices, regulatory requirements, and interdepartmental dependencies.
• Thorough knowledge and working experience with billing codes and requirements, UB and CMS1500 claim forms, medical terminology, and billing and reimbursement regulations.
• Strong leadership skills with an ability to motivate direct reports and support other internal leaders.
• Excellent communication skills both written and verbal.
• Must be able to manage and assess different situations that arise across various departments and produce quick, sound resolutions.
• Ability to work independently.
• Acute attention to detail.
• Proficient in all Microsoft Office Suite and computer application systems