[Hiring] Workers Compensation - Provider Contract Lead @Paradigm

Role Description

Develops and implements provider network and contract strategies, identifying the ambulatory surgery centers and specialists in geographic locations in which to concentrate resources for purposes of establishing a sufficient network of participating providers to serve and exceed the needs of our clients.

• Executes provider contracts for acceptable reimbursement rates as determined by client requirements and prevailing market ranges.
• Maintains a system to track contract negotiation and sales activity on an ongoing basis through company provided software applications.
• Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with ambulatory surgery centers, physicians, hospitals, and other health care providers as needed.
• Oversees the maintenance of all Provider contract information for given territory.
• Works with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Seeks, contacts and creates single case agreements (SCA) to fulfill GAP’s as needed by the business.
• Develops relationships with providers and offers feedback if there are deficiencies in their response time, scheduling time and/or providing medical documentation in a timely manner.
• Performs additional duties as identified and directed by management.
• Maintains reliable and predictable attendance during scheduled work hours.
• Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality.
• Demonstrates a customer-first mindset by developing a broad and deep understanding of Paradigm organization, products, operations, and customers.
• Responsible for complying with Paradigm Information Security requirements and policies.

Qualifications

• Bachelor’s Degree in a related field (Business Administration, etc.) or equivalent experience.
• 3 to 5 years of experience in Healthcare Administration, Network Development, Managed Care, and/or Provider Services.
• Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.
• Superior interpretation and research skills to readily identify problems and achieve prompt resolution.
• Ability to organize, coordinate, and accomplish a high volume of work with minimum impact on quality.
• Exceptional interpersonal relations skills.
• Superior verbal and written communication skills.
• Knowledge of Excel and Word.
• This position may require up to 10% travel.

Benefits

• Health and wellness: PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation: paid time off and personal holiday programs for work-life balance.
• Volunteer time: one paid day per calendar year for community engagement.
• Learning and development: support for continual learning through the Learning Excellence at Paradigm (LEAP) program.