Clinical Budgeting Specialist - Remote
Company: Paradigm Corp
Location: Walnut Creek
Posted on: October 19, 2024
Job Description:
Posted Tuesday, September 17, 2024 at 5:00 AM 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. We are seeking a full-time, remote Clinical Budgeting
Specialist. This position is responsible for the accuracy of
risk-based contract budgets and subsequent forecasts. This will be
accomplished by working in collaboration with multiple teams
including Clinical Operations, Provider Contracting, Bill Review,
Analytics, and senior management. RESPONSIBILITIES:
- Serve as a resource for Paradigm Clinical Management staff as
it relates to financial liability for all provider services and
other Contract-related costs.
- Partner with Director Clinical Solutions to manage the
development of all new Contract budgets, including participation in
clinical conferences.
- Research and document patient driven costs and provider rates
that drive budget development and management. Utilize web driven
and other electronic resources to identify potential costs,
including use of CPT codes in the company's electronic claims
adjudication system.
- Complete all Provider Rate Negotiation (PRN) requests to
include accurate documentation of known or estimated financial
liability in the system.
- Develop relationships with providers, including preferred
provider organizations (PPOs), hospitals and specialty providers,
ancillary services providers, and physicians.
- Maintain current knowledge of regulatory, industry and
contractual factors to ensure the accurate estimation of Paradigm's
liability on each Contract.
- Collaborate with other internal departments (Contracting, Bill
Review, Accounting) to address and resolve specific patient /
provider issues.
- Analyze contract budget to actual (frequency based on contract
parameters) to evaluate the clinical requirements and clinical
management requirements for both acute and chronic cases. Develop
action plans in collaboration with the PMT to manage the budget
expenditures in order to keep the Contract on track
financially.
- Collaborate with the clinical team including the Director of
Clinical Solutions to determine the current and future
medical/financial course and its impact to the financial
forecast.
- Complete detailed review of clinical progress reports for key
significant financial events and/or clinical confinements as well
as a comprehensive review of paid claims. Update each forecast with
findings/changes to include; update and confirmation of
known/future service dates and expense using reference data and/or
direct contract with the providers, true-up of forecast for
completed services to paid claims, adjustment for future services
based on changes in the clinical course of treatment.
- Work with the contracting department to request negotiations on
interim services, and escalate issues related to outstanding
confinement bills variations in paid claims estimates.
- Work with the Risk Analytics Team to determine trends and
identify improvements that can be made to enhance the accuracy and
ease of budget development and/or forecasting.
- Participate as required in Paradigm internal staff development
programs.
- Other duties as assigned. QUALIFICATIONS:
- Education - Bachelor's Degree in health care administration,
business, finance or a related field from an accredited college or
university or equivalent experience and education which
demonstrates the ability to perform the functions of the
position.
- Experience - A minimum or combination of five years of
experience with demonstrated success in health care or related
field.
- Must maintain current understanding of state regulations and
their impact on medical care and reimbursement in the workers'
compensation care market.
- Strong medical background to include comprehensive
understanding of medical terminology and health care principles and
practices.
- Demonstrated ability to multi-task in a fast-paced work
environment, assess importance of activities, and adjust priorities
when appropriate.
- Experience with various computer applications including
Microsoft Office, Outlook, Word and Excel.
- Language Skills - Excellent oral and written communication
skills; able to make presentations to audiences of varying levels,
size, nature and backgrounds.
- Reasoning Ability - Demonstrated ability to analyze difficult
situations, problems and data and develop feasible and effective
solutions. Demonstrated ability to implement and monitor project
responsibilities.
- Any combination of education, experience and knowledge that
demonstrate the ability to perform the functions of the position
will be accepted. 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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Keywords: Paradigm Corp, Fremont , Clinical Budgeting Specialist - Remote, Healthcare , Walnut Creek, California
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