Clinical Solutions Associate at Paradigm in Chicago, Illinois

Job Description:

Location:
Req Number: Req #1018
Date Posted: Thursday, April 18, 2024

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.

SUMMARY: This position holds accountability for providing support and backup to the Clinical Solutions Associate II (CSA II) team. Under the direction of the CSA team and the supervision of the VP Clinical Solutions Delivery & Senior Director Clinical Operations, this may include tracking of customer deliverables that meet targeted timelines and reflect and support patient management, facilitation of patient management team communication and general support of both the Network Manager and the Director Clinical Services (DCS) to ensure proactive, well-conceived and executed management plans.

DUTIES AND RESPONSIBILITIES:

• Support of development of contract budgets, including researching costs and ARCH budget entry and tracking of appropriate documents to support contract development. Participate and /or facilitate and document results of all patient related conferences as requested by the Director Clinical Services (DCS).
• Ensuring smooth administrative management of all assigned Paradigm cases, including tracking and routing of patient reimbursement requests, PRNs, PNFs, PCA requests and Health enrollment and disenrollment.
• Tracking of all customer deliverables to ensure timely submission that meet company Standards of Performance. Initiate appropriate action plans for late reports or contracts.
• Support timely development of Lifetime Medical Cost Estimates
• Participate in the report review process as required by established workflow procedures.
• Collaborate with other internal departments (Contracting, Bill Review, and Accounting) to address and resolve specific patient /provider issues.
• Other administrative duties as requested, including uploading of records in ECL, documentation and archiving of patient notes, research regarding patient specific issues and tracking of deliverables as requested.
• Participate in company projects requiring representation from the Clinical Solutions Associate II team, as requested by management.
• Responsible for complying with Paradigm IT security requirement and policies.
• Responsible for safeguarding Paradigm or Paradigm related IT passwords.
• Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management.

QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Education: Bachelor’s degree from an accredited educational institution preferred.
• Experience: Two to five years progressively responsible customer service experience. Related experience in provider relations or health care preferred. Strong medical background preferred, including comprehensive understanding of medical terminology and health care principles and practices. Demonstrated ability to multi-task in a fast paced work environment. Experience with various computer applications including Microsoft Office, Outlook, WORD and Excel.
• Language: Excellent oral communication skills and phone presence. Ability to read and comprehend instructions, correspondence, memos, and medical/patient reports. Ability to write correspondence and memos and utilize e-mail communication effectively. Ability to present information in one-on-one and small group situations.
• Reasoning Ability: Excellent analytical skills -- ability to define problems, collect data, establish facts, and draw valid conclusions; ability to interpret a variety of instructions and deal with abstract and concrete variables; demonstrated ability to analyze difficult situations, problems, and data; use good judgment and decision making.
• Any combination of education/experience and knowledge that demonstrates 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.

Other details

Job Family Active
Pay Type Hourly
Min Hiring Rate $48,200.00
Max Hiring Rate $60,000.00

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