Provider Contract Manager

Provider Contract Manager

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.

The Provider Contract Manager will grow and enhance Paradigm's Provider Network by negotiating contracts, amendments, establishing and maintaining relationships with providers to secure network participation contracts at company approved jurisdictional margins. The job role requires actively managing a team that involves mentoring/coaching the team, monitoring their progress that includes achieving their goals and assisting with their contracting initiatives.

Duties and Responsibilities:

• Monitor provider network performance and growth.
• Focus on growth, efficiency and performance of underdeveloped network segments/geographic locations by product line as assigned.
• Directly manage, provide leadership and mentoring to any direct reports.
• Maintain accurate and up-to-date provider data in organization's System.
• Assist with the enforcement of departmental quality assurance processes and procedures.
• Conduct regular reviews and audits of the provider network to ensure accurate data.
• Conduct and coordinate provider recruitment efforts and related activities, with duties including but not limited to:
• Utilize proprietary company information/programs as well as approved non-company systems/programs to identify provider prospects.
• Recruit and contract with Providers.
• Foster and maintain productive professional relationships with Paradigm providers.
• Communicate with and provide timely responses to provider inquiries in a manner that demonstrates the Paradigm way.
• Maintain a thorough understanding of Paradigm's service offerings and pricing thresholds.
• Participate in the development of marketing and outreach materials in collaboration with departmental instruction/needs.
• Document outreach efforts, review results, and modify approach as needed to achieve departmental recruitment objectives in the appropriate contact management system.
• Support ongoing process improvement activities related to provider recruitment and onboarding.
• Prepare written reports, correspondence, presentations, orientation materials, and other documentation.
• Perform research and analysis related to Provider network requirements and to identify opportunities for network expansion, with duties including but not limited to:
• Conduct market research to identify gaps in in the provider network, opportunities for network expansion and trends.
• Maintain knowledge of Paradigm Providers through direct dialogue.
• Research competitors and utilize available data to monitor hospital and health system network, including service offerings and rates.
• Facilitate the contracting process with Providers in collaboration with the SVP of Network Development.
• Leads adoption of AI-enabled tools within the team, ensuring effective integration into workflows. Coaches employees on appropriate usage, monitors impact on productivity and quality, and identifies opportunities for process improvement.
• Demonstrates a customer-first mindset by reinforcing expectations of all employees as drivers of customer excellence by actively fostering engagement, clarity, accountability, and support, recognizing that a positive and consistent employee experience directly influences service quality and customer outcomes.
• Responsible for complying with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.

Supervisory Responsibilities:

• Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback to achieve their best performance and goal attainment
• Set the tone for a strong Enterprise culture and high employee engagement.
• Ensure all team members understand, are trained in, and comply with Paradigm's security requirements and policies.
• Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.

Qualification Requirements:

• Minimum of 7-10 years' of contracting experience in the healthcare industry, specific to provider contracting of physicians, surgical facilities and ancillary services.
• Minimum of 4-5 years of supervisory experience in managing a team of individuals that perform physician, surgical facility and ancillary services contracting.
• Knowledgeable in interpreting and assessing CPT, HCP, DRG and Revenue codes.
• Experience with Medicare fee schedules, Work Comp fee schedules, UCR and Billed Charge reimbursement methodologies.
• 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.
• Inside sales experience a plus.
• Bilingual (English/Spanish) a plus.
• Workers' Compensation knowledge required.
• Group Health knowledge required.

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.

As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (16.765). Poster link: Contract Compliance Law Poster