Clinical Operations Specialist II

2 weeks ago

Tampa, Florida, United States Paradigm Full time

SUMMARY

This role is responsible for providing essential administrative support to the Director of Clinical Services (DCS) and the Network Manager (NWM) in the comprehensive oversight of contractual agreements. This includes monitoring all client deliverables to ensure they are completed within designated timelines, facilitating communication among patient management teams, and offering general assistance to both the Network Manager and the Director of Clinical Services to guarantee effective and strategic management plans. Additionally, the Clinical Solutions Associate II collaborates with Network Services to ensure designated Network Business Owners fully comprehend and support Paradigm's processes and directives.

DUTIES AND RESPONSIBILITIES:

  • Collaborate with the Director of Clinical Services to oversee the creation of new contracts, which involves participating in clinical meetings, tracking necessary documentation, and developing associated budgets and financial plans.
  • Assist in facilitating and documenting outcomes of patient-related meetings as directed by the Director of Clinical Services.
  • Investigate and record patient-related costs and provider rates that influence budget formulation and management. Utilize online and electronic resources to identify potential expenses, including the application of CPT codes within the company's electronic claims processing system.
  • Ensure efficient administrative management of all assigned Paradigm cases, including monitoring and directing patient reimbursement requests, PRNs, PNFs, and PCA requests.
  • Monitor all client deliverables to guarantee timely submissions that adhere to company Standards of Performance. Initiate appropriate action plans for overdue reports or contracts.
  • Provide guidance to the administrative team regarding the accurate entry of patient demographic information into the electronic data collection system.
  • Engage in the report review process as mandated by established workflow protocols.
  • Act as the primary administrative contact for case-specific Network Managers, offering information and guidance on deliverable timelines, budget management, and provider relations, while effectively managing case-specific inquiries from Network Managers, patients/families, or providers.
  • Coordinate with assigned administrative Network Business contacts, providing training on Paradigm's internal processes, product updates, and specific performance issues related to Network Managers.
  • Work in conjunction with other internal departments (Contracting, Bill Review, Accounting) to address and resolve specific patient/provider concerns.
  • Contribute to the development of procedures and workflows for the CSA team and the broader Clinical Operations team.
  • Participate in company initiatives requiring representation from the CSA II role, as requested by management.
  • Ensure equitable distribution of the case load among all CSA II roles.
  • All CSA II members will engage in the formulation and adoption of CSA best practices.
  • The CSA team is expected to provide mutual support and coverage as needed.
  • Adhere to Paradigm's IT security policies and requirements.
  • Safeguard Paradigm or Paradigm-related IT passwords.
  • Report any IT security incidents to Paradigm in accordance with policy 16.0 Information Security Incident Management.

QUALIFICATION REQUIREMENTS: To successfully perform this role, an individual must be able to execute each essential duty satisfactorily. The requirements listed below represent the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

  • Education: A Bachelor's degree from an accredited institution is preferred.
  • Experience: Three to five years of progressively responsible customer service experience. A minimum of three years in provider relations or healthcare is required. A strong medical background is essential, including a comprehensive understanding of medical terminology and healthcare principles. Demonstrated ability to manage multiple tasks in a fast-paced environment. Proficiency in various computer applications, including Microsoft Office, Outlook, Word, and Excel.
  • Language: Excellent verbal communication skills and phone etiquette. Ability to read and comprehend instructions, correspondence, memos, and medical/patient reports. Capable of writing correspondence and memos and utilizing email communication effectively. Ability to present information in one-on-one and small group settings.
  • Reasoning Ability: Strong analytical skills are necessary—ability to define problems, gather data, establish facts, and draw valid conclusions; ability to interpret a variety of instructions and manage abstract and concrete variables; demonstrated ability to analyze complex situations, problems, and data; use sound 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 is committed to fostering a diverse and inclusive workplace, which is central to our mission of helping more people and transforming lives. We strive to build a culture that reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. Achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone can bring their whole self to work.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based on race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, disability, or any other federal, state, or local protected class.

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