Senior Intake Coordinator

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.

SUMMARY:

Oversee and have a hands-on approach in coordinating all aspects of the account(s) designated. This role is fully aware of the specific client protocols and ensures each claim is to the client specifications in unison with those of Paradigm Specialty Networks and Operations (SN&O). Offer guidance within the organization on client specifications and interfaces with the front-line production staff at their designated clients in follow-up, problem-solving, clarification and additional documentation.

DUTIES AND RESPONSIBILITIES:

• Responsible for complying with Paradigm IT security requirement and policies.
• Responsible for safeguarding Paradigm or Paradigm related IT passwords.
• Responsible for notifying Paradigm of any IT security incidents per Policy No. 16.0 Information Security Incident Management.
• Provide facilitation and ownership of all assigned client accounts with a hands-on approach including client protocols, key contacts, trends, requests, enhancements, risks & opportunities.
• Work closely with multiple client frontline staff for successful operational functionalities of assigned program (programs).
• Provide phone support, email & mail communications with both clients & providers.
• Read, interpret & enter client claim information into SN&O’s system to properly complete core review functions.
• Enter specific items from claim documents including but not limited to: UB-04, HCFA 1500, Superbill, Manufacturer Invoices, Implant Logs, Operative Reports.
• Identify any inconsistencies in documentation for proper evaluation & information provided back to our clients.
• Work closely with interdepartmental operations staff to effectively process claim data.
• Understand the FSA calculations & savings output to clients with the ability to identify opportunities.
• Understand the Appeal/Reconsideration process.
• Understand & comply with all HIPAA & SOC2 requirements necessary in working with designated PHI.
• Perform additional duties as identified and directed by management.
  
  
  

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.

• Associate degree or equivalent number of years’ experience.
• Customer service experience in a call center or production client interfacing setting.
• Experience in medical billing, terminology & surgical implants.
• Consistent and efficient quality data entry utilizing problem solving and analysis.
• Attention to detail and proven organizational skills.
• Customer & client focus including incoming phone calls, faxes, mail & emails.
• Ability to utilize multiple systems to complete duties.
• Proficiency in all MS Office & computer application systems.
• Excellent verbal & written communication skills.
• Healthcare insurance & servicing organizations a plus.
• Minimum typing speed of 45 WPM.
• Bilingual (English/Spanish) a plus.
  
  
  

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.

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.

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