Use your deep workers’ compensation and medical billing expertise to lead complex provider appeals and legal coordination while working from home. This senior remote role is ideal for someone who can translate dense billing disputes into clear, defensible resolutions that keep both providers and legal teams aligned.
About Paradigm
Paradigm is a specialty care management organization that focuses on people with complex injuries and diagnoses. Since 1991, they have led value based care with strong clinical outcomes for patients, payers, and providers. They are a certified Great Place to Work® and consistently ranked on Fortune’s Best Workplaces in Health Care list.
Schedule
- Full time, salaried position
- Monday through Friday, 8:00 a.m. to 5:00 p.m. (local time)
- Fully remote
- Open to candidates in Florida, Texas, and Arizona
What You’ll Do
- Serve as the main liaison between Medical Bill Review, Complex Claims, and Legal for provider disputes, appeals, and regulatory filings
- Lead resolution of complex provider billing appeals and reconsiderations
- Draft and refine clear, defensible written responses to providers and legal teams
- Review legal documents related to billing disputes and escalate or seek guidance when needed
- Maintain expert level knowledge of workers’ compensation fee schedules, coding standards, and bill review methodologies
- Identify patterns in disputes, recommend process improvements, and support internal training
- Represent Medical Bill Review in meetings with Compliance, Provider Relations, and Network Development
- Ensure accurate documentation and maintain audit ready records for all work
- Support cross functional collaboration to improve payment integrity and dispute outcomes
What You Need
- Bachelor’s degree or equivalent experience (advanced coursework in healthcare administration, legal studies, or medical billing is a plus)
- At least 7 years of national workers’ compensation bill review experience
- At least 3 years in appeals, reconsiderations, or legal coordination roles
- Advanced understanding of medical billing and coding (ICD 10, CPT, HCPCS) and workers’ compensation regulations
- Excellent written and verbal communication skills and a strong, professional phone presence
- Strong analytical and critical thinking skills with proven ability to handle complex cases
- Experience collaborating with legal, compliance, and operational teams
- Proficiency with Microsoft Office and bill review platforms
- High attention to detail with strong organizational and time management skills
Benefits
- Medical, dental, and vision insurance with multiple plan options (PPO, HDHP, HMO; Kaiser available for eligible CA employees)
- Competitive salary with 401(k) matching contributions
- Employer paid life and disability insurance
- Flexible spending accounts and commuter accounts
- Employer matched HSA contributions (for eligible plans)
- Paid time off, plus personal holiday programs for work life balance
- One paid volunteer day per year to give back to your community
- Robust learning and development support through programs like LEAP
Roles at this level do not stay open long, so if you are qualified, do not sit on it.
If you are ready to bring your workers’ compensation and appeals expertise to a mission driven healthcare team, this is your next move.
Happy Hunting,
~Two Chicks…