Provider Relations Specialist

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.
• Aid in coordinating provider onboarding and education related to Paradigm programs and expectations.
• Help monitor vendor deliverables and escalate issues to the Director as appropriate.
• Aid 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.
• Aid in 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.