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