The Medical Bill Processor is responsible for ensuring accurate and timely processing and

payment of bills, including pre-coding, data entry, and adjudication of non-medical claims. This

role also involves conducting provider outreach and obtaining necessary documentation and

data to support claim processing.

II. DUTIES & RESPONSIBILITIES

1. Examines, enters, and adjudicates Network Manager (NWM) bills to include case

coding, vendor look-up, data entry, calculating benefits based on provider contract

discounts, plans, exclusions

2. Examines, enters, and adjudicates patient reimbursement bills, PCA invoices,

prescription bills, and medical bills/claims to include case coding, vendor look-up, data

entry, calculating benefits based on provider contract discounts, rates, plans,

exclusions

3. Enters and adjudicates injured worker reimbursement forms including reviewing form

for proper documentation, calculating benefits, and ensuring timeliness of payment

4. Reviews keying exception queue to bill image to accurately key the bill into the bill

review system

5. Enters other non-medical bills into bill review system for processing

6. Conduct proactive outreach to healthcare providers via phone and/or email to obtain

necessary documentation and data, ensuring accurate and timely payments.

7. Maintain accurate and detailed records of all outreach activities and communications

within the company’s CRM system.

8. Meets or exceeds department contractual and/or industry standards for accuracy and

turnaround time

9. Tracks and reports production, downtime, issues, and trends

10. Correspondence with Business Owners (BO), Network Managers (NWM), Clinical

Service Associates (CSA), patients & providers

11. Responsible for complying with Paradigm IT security requirements and policies

12. Responsible for safeguarding Paradigm or Paradigm related IT passwords

13. Responsible for notifying Paradigm of any IT security incidents per policy 16.0

Information Security Incident Management

14. May be responsible for special projects

III. JOB REQUIREMENTS

Education  Any Bachelor's Degree graduate; successful completion of continuing

education in insurance, medical terminology/coding, and/or

accounting preferred

Experience  2 years customer service experience with a minimum of 2

years claims or bill review experience and provider/carrier

outreach with Intermediate computer experience using

Microsoft Word, Excel & Outlook required

Eligibility

(Training, License,

Certification)



Competencies

(Knowledge, Skills,

Attitudes)

 Typing speed of 45 WPM and 10-key experience.

Excellent organizational skills. Knowledge of ICD-9;

CPT; RVS; U&C; Fee Schedule; HCPCS & other coding

schemes preferred.

 Language Skills - Excellent oral communication skills

and phone presence. Ability to effectively present

information to providers as well as to employees of the

organization

 Reasoning Ability - Ability to define problems, collect

data, establish facts, and draw valid conclusions. Ability

to interpret a variety of instructions and deal with abstract

and concrete variables.