Provider Contract Administrator
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.
Requirements
- 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
- Responsible for complying with Paradigm IT security requirement and policies.
- Responsible for safeguarding Paradigm or Paradigm related IT passwords.
- Responsible for notifying Paradigm of any IT security incidents per Policy No. 16.0 Information Security Incident Management.
- 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
- PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
- Competitive salaries
- 401(k) matching contributions
- Employer-paid life and disability insurance
- Flexible spending and commuter accounts
- Employer-matched HSA contributions
- Paid time off
- Personal holiday programs
- One paid day per calendar year for volunteer time
- Learning and development programs
- Learning Excellence at Paradigm (LEAP) program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
