Provider Contract Lead in East Texas, Pennsylvania at Paradigm

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.

Paradigm is hiring a full-time, remote Provider Contract Lead. The Provider Contract Lead 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.

DUTIES AND RESPONSIBILITIES:

• Executes provider contracts for acceptable reimbursement rates as determined by client requirements and prevailing market ranges.
• Maintain 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.

QUALIFICATION REQUIREMENTS:

• 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.
• 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, get to the root cause and achieve prompt resolution to problems and issues including analytical skills
• 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.