Provider Relations Specialist

Provider Relations Specialist

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.

Paradigm is seeking a full-time, fully remote Provider Relations Specialist to join our team. In this pivotal role, you will leverage your 4+ years of experience in provider relations and contract development to support our provider network strategy, maintain strong relationships, and contribute to cost-effective care solutions.

The Provider Relations Specialist supports Paradigm's provider network strategy by assisting in relationship management, contracting activities, and vendor coordination. This role is responsible for helping to maintain strong provider relationships, coordinating single case agreements, and supporting cost-effective care solutions. The associate will contribute to the execution of strategies developed by the Director and will serve as a liaison with providers, vendors, and internal stakeholders to ensure alignment with Paradigm's financial and operational goals.

This is a remote work opportunity

Duties and Responsibilities:

• Serve as a day-to-day point of contact for providers regarding inquiries, documentation, and follow-up on active negotiations.
• Facilitate key provider relationships including performing monthly reviews, QBR's and annual stewardships with select providers.
• Support management of key vendor/partner relationships including but not limited to participating in monthly reviews, QBR's and annual stewardships.
• Support the execution and tracking of single case agreements (SCAs), letters of agreement (LOAs), and other provider arrangements.
• Maintain accurate contract records and provider contact logs, support preparation of documentation and materials for provider discussions.
• Assist in coordinating provider onboarding and education related to Paradigm programs and expectations.
• Help monitor vendor deliverables and escalate issues to the Director as appropriate.
• Assist in data tracking and reporting related to vendor and partner performance.
• Compile and analyze data to support provider engagement, payment strategy, and network optimization initiatives.
• Prepare summary reports or visualizations for internal and external stakeholders as requested.
• Assist with identifying trends or provider issues based on contract and billing data.

Qualification Requirements:

• Excellent provider-facing and internal communication skills.
• 4+ years of experience in provider relations and contract development.
• Excellent written and verbal communication skills.
• Familiarity with reference-based pricing models, single case agreements, and facility contracting concepts.
• Solid organizational skills including attention to detail and multitasking skills.
• Strong working knowledge of Workers Compensation fee schedules, CMS methodology, medical coding and other standard billing practices.
• Strong organizational skills and ability to manage multiple priorities effectively.
• Some Commercial healthcare experience strongly preferred.
• Bachelor's Degree in appropriate field of study or equivalent work experience.

Paradigm Benefits:

• Health and wellness We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives Paradigm's financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
• Volunteer time We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.

Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We're striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.

Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at View email address on click.appcast.io.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.