Provider Contract Manager

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Expand and improve Paradigm’s Provider Network through contract negotiations.

• Actively oversee a team, focusing on mentoring and coaching its members.

• Track the performance and growth of the provider network.

• Emphasize growth, efficiency, and performance in underdeveloped network segments and geographic areas.

• Directly supervise and provide leadership and mentorship to any direct reports.

• Ensure the provider data in the organization's system is accurate and current.

• Assist in enforcing departmental quality assurance processes and procedures.

• Conduct regular reviews and audits of the provider network to verify data accuracy.

• Organize and coordinate recruitment efforts for providers.

• Utilize proprietary company information and programs to identify potential provider prospects.

• Recruit and establish contracts with Providers.

• Build and maintain positive professional relationships with Paradigm providers.

• Prepare written documentation, including reports, correspondence, presentations, and orientation materials.

• Conduct research and analysis related to Provider network needs.

• Perform market research to identify deficiencies in the provider network.

• Facilitate the contracting process with providers.

⛳️ Requirements

• A minimum of 7-10 years of contracting experience in the healthcare sector, specifically in provider contracting for physicians, surgical facilities, and ancillary services.

• At least 4-5 years of supervisory experience managing a team involved in contracting for physicians, surgical facilities, and ancillary services.

• Proficient in interpreting and assessing CPT, HCP, DRG, and Revenue codes.

• Familiar with Medicare fee schedules, Work Comp fee schedules, UCR, and billed charge reimbursement methodologies.

• College degree preferred; a high school diploma or equivalent is acceptable with relevant experience.

• Excellent communication and telephone skills are essential, along with a high degree of patience, understanding, and tact.

• High level of self-confidence and persistence; assertive approach in dealings with providers is required.

• Exceptional organizational skills and the ability to multi-task effectively.

• Ability to prioritize a heavy workload independently with minimal supervision.

• Proficient in computer and internet skills; familiarity with Microsoft applications is required.

• Will develop a thorough understanding of department and company internal workflows, including jurisdictional statutes, procedures, and negotiation protocols.

• Inside sales experience is a plus.

• Bilingual (English/Spanish) is a plus.

• Knowledge of Workers’ Compensation is required.

• Understanding of Group Health is required.

🏝️ Benefits

• Adherence to Paradigm Information Security requirements and policies.

• Protection of Paradigm or Paradigm-related passwords.

• Promptly notifying Paradigm of any Information Security incidents as per policy SEC 10-12 Information Security Incident Management.