Provider Contract Administrator

Paradigm • Tampa, FL

3d • Remote

About The Position

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.
To establish relationships with providers to secure single-case agreements and permanent contracts at company approved jurisdictional margins. This may include delivering care coordination services on behalf of Paradigm’s clients.

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.

Nice To Haves

• Call center experience a plus.
• Bilingual (English/Spanish) a plus.
• Workers compensation knowledge a plus.

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.
• Calls physician and post-acute care provider prospects to explain company services and solicit/negotiate with them to accept referral via single case agreements with option for further referrals – deploying tactful negotiation skills. This may include coordinating specifics types of post-acute care services with support from a post-acute care subject matter expert to ensure appropriate provider placement based upon the patient/injured worker’s health status.
• Prepare single patient contract and submit to physician/provider.
• Schedule initial appointment for most referrals. For post-acute care referrals ensuring the client’s case management points of contact are engaged with the provider and (where appropriate) ensuring a Paradigm Care Coordination team member is utilized to facilitate the flow of clinical information while the injured worker being treated.
• Follow up with provider to ensure single case agreement has been signed and returned.
• Follow up with provider regarding full participation.
• Prepare, submit, negotiate and secure participation agreement as applicable.
• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED