Provider Contract Administrator

Paradigm•Tampa, FL

About The Position

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

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.
Call 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.
Coordinate 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.
Ensure 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.
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.