Bill Review Process Analyst

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. We are seeking a full-time, remote Bill Review Process Analyst. The Bill Review Process Analyst is responsible for analyzing Bill Review operational processes to identify and implement changes to improve performance on key performance indicators including productivity, reliability, quality, and efficiency. The schedule for this position is Monday - Friday, 8 AM to 5 PM Central Time. This position may require travel 1-2 times per year. Responsibilities include (but are not limited to): Data and System Support Identify and resolve data issues for clients and vendors Provide system testing and support for data reporting processes Document and communicate solutions for system and customer-specific requirements Compliance and Bill Review Coordination Coordinate internal audits and reviews with the Clinical Bill Review team Collaborate with Bill Review leaders to implement process and system changes Process Improvement and Analysis Lead and support process improvement initiatives focused on efficiency, quality, and cost savings Analyze current processes and metrics to recommend and implement improvements Project and Change Management Manage re-engineering and strategic projects, including UAT and stakeholder communication Assist project and program managers with key initiatives and maintain process documentation Leadership and Security Compliance Develop leadership skills and contribute to team strategy Ensure compliance with information security policies and report incidents as required Required qualifications: Bachelor's Degree in appropriate field of study or equivalent work experience Knowledge of process assessment and optimization techniques Proven working experience in project management and change management environment Excellent client-facing and internal technical communication skills Excellent written and verbal communication skills Solid organizational skills including attention to detail and multitasking skills Strong working knowledge of Microsoft Office and Visio Highly Preferred: experience working in claims processing systems, ideally in the Workers Compensation industry Preferred qualifications: Process mapping and documentation: experience with Visio, BPMN Data analysis and reporting: experience using Excel, Tableau, Power BI Process improvement methodologies such as Lean, Six Sigma Bill review process expertise: deep understanding of bill review workflows; ability to translate operational knowledge into process improvements. Claims processing and medical billing: claims adjudication, medical billing coding (CPT, ICD-10, HCPCS) and regulatory requirements (work comp, PPOs) Healthcare regulations and compliance: experience with HIPAA, HITECH, Medicare/Medicaid Vendor management: manage relationships with external vendors and tech partners Stakeholder engagement: collaborate with bill review teams, SMEs, and leadership to understand workflows and drive change Paradigm Benefits: Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only). Financial incentives – Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions. Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest. Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year. Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program. Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work. Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at [email protected]. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster #LI-Remote