Description
Location: Tampa, FL, USA• Florida, USA• Arizona, USA• Texas, USA
Req Number: Req #1589
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, remote Provider Appeals and Legal Liaison. The Provider Appeals and Legal Liaison is responsible for leading the interface between the Medical Bill Review/Claims team and Paradigm's Legal department. This position manages complex medical provider appeals and reconsiderations, supports legal responses to medical billing disputes, and ensures compliance with Workers' Compensation regulations and best practices. The ideal candidate brings deep subject matter expertise, advanced analytical capabilities, and exceptional communication skills to drive resolution and influence cross-functional collaboration.
The schedule for this position is Monday - Friday, 8 AM to 5 PM. Infrequent travel may be required.
Responsibilities include (but are not limited to):
- Provider Dispute Resolution
- Serve as the main liaison between Medical Bill Review, Complex Claims, and Legal for repricing disputes, appeals, and regulatory filings
- Lead resolution efforts for complex provider appeals and billing reconsiderations
- Legal Collaboration and Documentation
- Draft and refine clear, defensible responses to providers and legal teams
- Review legal documents and escalate or seek guidance as needed
- Expertise in Billing Standards
- Maintain deep knowledge of Workers' Compensation fee schedules, coding standards, and bill review methodologies
- Trend Analysis and Process Improvement
- Identify patterns in provider disputes and recommend proactive solutions
- Support internal training and share best practices across teams
- Cross-Functional Engagement and Recordkeeping
- Represent Medical Bill Review in meetings with Compliance, Provider Relations, and Network Development
- Ensure accurate documentation and maintain audit-ready records
Qualifications:
- Bachelor's degree or equivalent experience required; advanced coursework in healthcare administration, legal studies, or medical billing preferred.
- Minimum 7 years of national Workers' Compensation bill review experience, with at least 3 years in a role involving appeals, reconsiderations, or legal coordination.
- Excellent written and oral communication skills and phone presence. Ability to effectively present information to providers as well as to employees of the organization
- Advanced understanding of medical billing, coding (ICD-10, CPT, HCPCS), and Workers' Compensation regulations.
- Strong analytical and critical thinking abilities.
- Proven ability to collaborate effectively with legal, compliance, and operational teams.
- Proficiency in Microsoft Office and bill review platforms.
- Detail-oriented with excellent organizational and time management skills.
Paradigm Benefits:
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 leave.management@paradigmcorp.com.
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.
Other details
PI279554515
