Senior Provider Contract 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 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.

SUMMARY: The primary responsibility is to establish relationships with orthopedic and pain management physician groups to secure network participation contracts at company approved jurisdictional threshold rates and margins. 

DUTIES AND RESPONSIBILITIES: 

• Utilize proprietary company information/programs as well as non-company systems/programs to identify physician prospects.
• Gather and submit provider/physician demographics/web address and submit for entry into company programs.
• Utilize proprietary company programs/tools to identify optimal reimbursement range.
• Call orthopedic and pain management physician groups to explain company services and solicit/negotiate with them to become participating network providers – deploying tactful negotiation skills.
• Schedule and perform meetings with C-Level suite executives to discuss advantages of establishing a business relationship with Paradigm.
• Minimum of 7-10 years of experience with recruiting and contracting physician groups and ambulatory surgery center (ASC) facilities.
• The ability to think and work strategically as an individual to pursue arrangements with medical providers that would enhance the quality of the Paradigm network.
• Prior experience with performing an analysis of network adequacy, access, reimbursement methodologies and geographic coverage.
• Familiar with Medicare part B, CPT, HCPC, Revenue and DRG codes.
• Negotiate competitive work comp industry provider rates that encompass complex business relationships with Managed Service Organizations (MSOs), hospitals, healthcare systems in order to prepare, and submit network participation contracts as well as other paperwork to physicians and other types of providers.
• Follow up with providers regarding full participation and secure participation agreements.
• Update proprietary programs daily- documenting efforts.
• Act as a resource to answer any general provider contracting questions.
• Perform data-analysis as requested by management.
• Assist management in training new associates.
• Perform additional duties as identified and directed by management.
• Maintain reliable and predictable attendance during scheduled work hours.
• 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.
• 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.

QUALIFICATION REQUIREMENTS: 

• College degree preferred. High school diploma or equivalent acceptable with commensurate experience.
• Exceptional communication and telephone skills required, as well as a great deal of patience, understanding and tact.
• Possess a high level of self-confidence and persistence; maintain an assertive approach in dealing with providers.
• Must possess excellent organizational skills and ability to multi-task effectively.
• Demonstrate the ability to prioritize heavy workload independently with minimal supervision.
• Proficient computer and internet skills; familiarity with Microsoft applications required.
• Will develop in-depth knowledge of department and company internal workflows, including but not limited to individual jurisdictional statutes, procedures, and negotiating protocols.
• Inside sales experience a plus.
• Bilingual (English/Spanish) a plus.
• Workers compensation knowledge a plus.
• Medical industry knowledge a plus.

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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