Provider Contract Administrator at Paradigm – Tampa, Florida

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.

DUTIES AND 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.

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