<p>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.</p> <p>The schedule for this remote work position is Monday - Friday, 8 AM to 5 PM.</p> <p>Responsibilities include (but are not limited to):</p> <p>Workers' Compensation Medical Bill Review and Provider AppealsReview and process provider appeals and complex billing reconsiderations for medical bills associated with complex Workers' Compensation claims Legal and State Dispute SupportAct as the billing SME when disputes escalate to state WC boards. Display strong analytical & communications through compilation of end-to-end provider billing history, payment rationale, and regulatory citations to support Legal in drafting responses and negotiations. Jurisdictional ExpertiseApply deep knowledge of Workers' Compensation regulations, statutes, and fee schedules across multiple states. Serve as SME for state-specific billing requirements and dispute processes. Medical Billing Standards and ComplianceMaintain expertise in Workers' compensation fee schedules, medical billing and coding standards (CPT, ICD-10, HCPCS), and payer-side bill review methodologies, while ensuring compliance with all regulatory requirements. Trend Analysis and Process ImprovementIdentify patterns in provider disputes, recommend proactive solutions, and share best practices through training and collaboration. Cross-Functional Engagement and DocumentationRepresent Medical Bill Review in meetings with Legal, Compliance and Provider Relations. Maintain accurate, audit-ready records for appeals and disputes.</p> <p>Qualifications:</p> <p>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.</p>