Remote Prior Authorization Jobs in New Port Richey, FL

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 recognized—again!  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.

Watch this short video for a brief introduction to Paradigm.

We are seeking a full-time, fully remote DME Referral Care Coordinator to support a fast-paced, high-volume referral coordination team focused on general durable medical equipment (e.g., wheelchairs, walkers, canes, crutches, and related supplies). In this role, you’ll partner closely with referral sources, injured workers/patients, and DME providers to ensure timely authorization, ordering, status updates, and delivery confirmation—while maintaining accuracy, excellent customer service, and compliance. Candidates must have hands-on familiarity with general DME and be comfortable managing multiple priorities in a production-driven environment. Schedule is Monday–Friday, 9:00 a.m.–5:30 p.m. Eastern Time.

Responsibilities: 

• Receive DME referrals, communicate status and receipt of DME to referral sources. Ensure written authorization from payor source prior to delivery of equipment. Provide updates to referral sources, provider, and injured worker as well as confirmation of DME delivery. Work closely with referral sources, injured workers and DME providers to ensure appropriate DME is delivered in a specified timeframe. Follow up with injured workers and referral sources in a timely manner to ensure customer satisfaction.
• Provide accurate, timely pricing to the Billing Department to ensure DME billing is accurate. Expand current list of DME providers, mindful to secure best possible pricing for equipment.
• Coordinate specific work tasks with internal teams as needed to ensure smooth and efficient flow of information. Responsive to inquiries within given timeframes and within established policy. Appropriately follow up with supervisor, co-workers or residents regarding reported complaints, problems, and concerns.
• Positively support the mission, values, and vision of Paradigm Corp. through effective communication with internal and external customers, serve as positive role model, demonstrate excellent customer service, and comply with all applicable regulatory requirements and Quality Assurance initiatives, including providing a work environment free from all illegal and discriminatory behavior and harassment, including sexual harassment.
• Duties may include taking call on weekends, for which compensation will be provided.
• Maintain reliable and predictable attendance during scheduled work hours.

Qualifications: 

• Education/Training: Some college credit and/or experience in a related discipline.
• Experience: At least one (1) year of related experience (e.g., healthcare, DME, insurance, physician practice).
• Skills: Excellent communication skills, verbal and written; Proficient in reading, grammar, and mathematics. Strong computer skills (e.g., Outlook, Excel, Word, Teams, proprietary software for which training will be provided); Accuracy and efficiency required. Excellent organizational, prioritization and multi-tasking skills. Knowledgeable of medical terminology.
• Maintain Confidentiality of all data, including ensuring protection injured workers’ rights, Protected Health Information (PHI), employee, and operations data.
• Compliance with all regulatory requirements, current laws and policies which protect workers from harassment and all illegal and discriminatory behavior. Comply with applicable Quality Assurance initiatives.
• Complete requirements for required training, demonstrate acceptable attendance, and appropriate personal appearance.
• Cooperate and work well together with all co-workers, ensuring all communication is professional and cordial; Plan, execute and complete job duties with minimal supervisory direction, utilizing appropriate sound judgment.
• Equipment/Machinery Used: Standard office equipment including phones, calculators, copiers, scanners, fax, laptop/PC, copiers, various computer programs, mailing equipment, etc.

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 leave.management@paradigmcorp.com.  

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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