Worker's Compensation Senior Provider Contract Specialist

Paradigm • Tampa, FL

127d • $38 - $45 • Remote

About The Position

The Worker’s Compensation Senior Provider Contract Specialist establishes relationships with orthopedic and pain management physician groups to secure network participation contracts at company-approved jurisdictional threshold rates and margins. The role identifies physician prospects, evaluates reimbursement ranges, explains Paradigm’s services, and negotiates provider participation agreements. It also analyzes network adequacy, access, reimbursement methodologies, and geographic coverage, and negotiates rates with providers and complex healthcare organizations.

The specialist maintains accurate records in company programs, follows up with providers to secure participation agreements, answers provider contracting questions, performs requested data analysis, and assists with training new associates. The position requires dependable attendance, compliance with information security policies, and use of AI tools and other new technologies in accordance with established processes and guidelines.

Requirements

• 7–10 years of experience recruiting and contracting physician groups and ambulatory surgery center facilities.
• Experience analyzing network adequacy, access, reimbursement methodologies, and geographic coverage.
• Familiarity with Medicare Part B, CPT, HCPC, revenue, and DRG codes.
• Exceptional communication and telephone skills, patience, understanding, and tact.
• High self-confidence and persistence, with an assertive approach when dealing with providers.
• Excellent organizational skills and ability to multitask effectively.
• Ability to independently prioritize a heavy workload with minimal supervision.
• Proficient computer and internet skills; familiarity with Microsoft applications.
• Ability to develop in-depth knowledge of department and company workflows, including jurisdictional statutes, procedures, and negotiating protocols.
• High school diploma or equivalent; commensurate experience is acceptable if no college degree.

Nice To Haves

• College degree preferred.
• Inside sales experience.
• Bilingual English/Spanish skills.
• Workers’ compensation knowledge.
• Medical industry knowledge.

Responsibilities

• Use company and external systems to identify physician prospects.
• Gather provider and physician demographics and website information and submit it for entry into company programs.
• Use company tools to identify optimal reimbursement ranges.
• Contact orthopedic and pain management physician groups, explain company services, and negotiate their participation in the network.
• Schedule and conduct meetings with C-level executives to discuss a business relationship with Paradigm.
• Strategically pursue provider arrangements that enhance the quality of the Paradigm network.
• Analyze network adequacy, access, reimbursement methodologies, and geographic coverage.
• Negotiate competitive workers’ compensation provider rates with MSOs, hospitals, and healthcare systems; prepare and submit participation contracts and other paperwork.
• Follow up with providers regarding participation and secure participation agreements.
• Update company programs daily to document efforts.
• Answer general provider contracting questions as a resource.
• Perform data analysis as requested by management.
• Assist management in training new associates.
• Perform additional duties as directed by management.
• Maintain reliable and predictable attendance during scheduled work hours.
• Comply with information security requirements, safeguard passwords, and report security incidents under company policy.
• Use AI tools to support daily work, improve efficiency, and enhance output quality; adopt new technologies as trained and apply them according to established guidelines.

Benefits

• PPO, HDHP, and HMO health insurance options through Cigna; Kaiser options for California employees.
• 401(k) matching contributions.
• Employer-paid life and disability insurance.
• Flexible spending and commuter accounts.
• Employer-matched HSA contributions.
• Paid time off and personal holiday programs.
• One paid volunteer day per calendar year for full- and part-time employees.
• Learning and development support, including the Learning Excellence at Paradigm (LEAP) program.

What This Job Offers

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