Provider Contract Manager

About the role

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.

Responsibilities

• 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 Provider’s.
• 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.
• 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 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.
• Lead the adoption of AI-enabled tools within the team, ensuring effective integration into workflows.
• Coach employees on appropriate usage, monitors impact on productivity and quality, and identifies opportunities for process improvement.
• Demonstrate 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.

Qualifications

• 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.
• Work’s Compensation knowledge required.
• Group Health knowledge required.