Medical Revenue Cycle - Payment Specialist

Payment Specialist

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're proud to be recognizedagain! For the fourth year in a row, we've been certified by Great Place to Work, and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

The Payment Specialist is responsible for managing the end-to-end payment process, ensuring accuracy, compliance, and timely disbursement of funds to external vendors and providers. This role exercises independent judgment in resolving complex payment issues, performs advanced analysis of payment trends, and leads process improvement initiatives. The Payment Specialist serves as a subject matter expert (SME) and key liaison across internal teams and external partners to enhance operational efficiency and payment accuracy.

Duties And Responsibilities:

• Prepare, audit, and generate complex payment files for submission to payment vendors in accordance with established schedules, client requirements, and regulatory guidelines
• Validate payment file accuracy through detailed review of payment data, provider information, offsets, adjustments, and reconciliation balancing
• Submit payment files through designated vendor platforms and ensure successful transmission, receipt, and processing
• Monitor payment submissions for rejections, exceptions, or error notifications and take immediate corrective action to prevent payment delays
• Perform detailed reconciliations between vendor platforms, internal systems, bank reporting, and payment batches to ensure financial accuracy and completeness
• Research, analyze, troubleshoot, and resolve payment file discrepancies, balancing issues, and processing errors in a timely manner
• Serve as a subject matter resource and liaison for provider payment release requests, escalated inquiries, and payment status investigations
• Process payment reissue, void, stop payment, recoupment, and offset requests in accordance with department procedures and compliance standards
• Create and validate client refund files for Accounting department processing and reconciliation
• Collaborate cross functionally with internal departments, external vendors, banking partners, and IT resources to resolve discrepancies, transmission failures, and file format issues
• Maintain detailed documentation and audit ready records of payment submissions, corrections, reconciliations, approvals, and outcomes
• Analyze payment activity trends and provide reporting related to payment accuracy, aging, rejection trends, reconciliation findings, and resolution timelines
• Identify operational risks, process inefficiencies, and recurring payment issues and recommend process improvements to enhance accuracy, reduce rework, and improve turnaround times
• Support revenue cycle operations through accurate and timely disbursement processing while ensuring adherence to client contractual obligations and departmental service levels
• Generate, analyze, and reconcile reports from Data Warehouse and applicable systems to identify Provider Accounts Payable due and outstanding payment activity
• Reconcile Jopari payment acknowledgement reports against payment batch files to identify invoices requiring voids, corrections, or internal reprocessing
• Generate Explanation of Reimbursement (EOR) documentation and coordinate distribution processes
• Manage and prioritize the AP queue for provider payment requests, escalations, research items, and inquiries while maintaining service expectations
• Generate and review outstanding AP reports with Manager, Revenue Management and assist in identifying trends, risks, and resolution strategies
• Assist with departmental audits, special projects, workflow enhancements, system testing, and implementation initiatives as assigned
• Provide support and training to team members regarding payment processing workflows, reconciliation procedures, and issue resolution processes
• Maintain confidentiality and safeguard sensitive financial, provider, and client information in compliance with company policies and regulatory standards
• Maintain reliable and predictable attendance during scheduled work hours.
• Demonstrates a customer-first mindset by developing a broad and deep (where appropriate) understanding of Paradigm organization, products, operations, and customers. Prioritizes collaboration to meet customer needs and expectations and takes personal accountability for service quality.
• Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopts new technologies as trained and applies them in alignment with established processes and guidelines.
• Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.

Qualification Requirements:

• Acute attention to detail
• Understanding of medical billing, short payments and denials
• Reconciliation between various systems
• Strong interpersonal skills
• Ability to communicate professionally and effectively on the phone, in person, electronically, or through other means to individuals and groups
• Ability to deal effectively with individuals at all organizational levels
• Proven ability to handle multiple projects while meeting deadlines
• Ability to read and comprehend simple instructions, short correspondence, memos, and other documentation
• Commitment to excellence and high standards
• Ability to work independently and as a member of various teams and committees
• Must be able to speak, read, write, and understand the primary language(s) used in the workplace: English
• Technical capacity including advanced knowledge of Microsoft Excel and familiarity with Microsoft Access

Paradigm Benefits:

• Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.

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.

Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at View email address on click.appcast.io.

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.

As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (16.765). Poster link: Contract Compliance Law Poster

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