Clinical Budgeting Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Act as a key resource for Paradigm Clinical Management personnel regarding financial liabilities associated with all provider services and other costs related to contracts.

• Collaborate with the Director of Clinical Solutions to oversee the formulation of all new contract budgets.

• Investigate and document patient-related expenses and provider rates that are essential for budget creation and management.

• Fulfill all Provider Rate Negotiation (PRN) requests, ensuring thorough documentation of known or estimated financial liabilities in the system.

• Build and maintain relationships with providers, including preferred provider organizations (PPOs), hospitals, and specialty care providers.

• Stay updated on regulatory, industry, and contractual elements to guarantee precise estimation of Paradigm’s financial obligations.

• Work collaboratively with other internal teams to tackle and resolve specific patient and provider-related issues.

• Analyze the variance between contract budgets and actuals to assess clinical requirements and devise action plans.

• Partner with the Risk Analytics Team to identify trends and suggest enhancements for improving the accuracy and efficiency of budget development and forecasting.

• Leverage AI tools to assist with daily tasks and embrace new technologies as instructed.

⛳️ Requirements

• Bachelor’s Degree in health care administration, business, finance, or a related field.

• A minimum of five years of experience or a combination of experience with proven success in the healthcare sector or a related field.

• Medical coding certification is preferred.

• Experience in medical billing within the workers' compensation industry is preferred.

• Previous experience in reviewing medical documentation and assigning CPT codes for determining workers’ compensation fee schedule reimbursements.

• Must possess a current understanding of state regulations and their implications on medical care and reimbursement in the workers’ compensation market.

• Strong medical background with a thorough understanding of medical terminology and healthcare principles and practices.

• Proven ability to manage multiple tasks in a fast-paced environment, evaluate the significance of activities, and reprioritize as necessary.

• Proficient in various computer applications, including Microsoft Office, Outlook, Word, and Excel.

• Exceptional oral and written communication skills; capable of delivering presentations to diverse audiences of varying sizes and backgrounds.

• Demonstrated ability to analyze complex situations, issues, and data to develop viable and effective solutions.

• Any combination of education, experience, and knowledge that illustrates the capability to perform the job functions will be accepted.

🏝️ Benefits

• Health insurance

• Flexible work arrangements

• Professional development