Develops and implements provider network and contract strategies, identifying the ambulatory surgery centers and specialists in geographic locations in which to concentrate resources for purposes of establishing a sufficient network of participating providers to serve and exceed the needs of our clients.
DUTIES AND RESPONSIBILITIES:- Executes provider contracts for acceptable reimbursement rates as determined by client requirements and prevailing market ranges.
- Maintain a system to track contract negotiation and sales activity on an ongoing basis through company provided software applications.
- Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with ambulatory surgery centers, physicians, hospitals, and other health care providers as needed.
- Oversees the maintenance of all Provider contract information for given territory. Works with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
- Seeks, contacts and creates single case agreements (SCA) to fulfill GAP's as needed by the business.
- Develops relationships with providers and offers feedback if there are deficiencies in their response time, scheduling time and/or providing medical documentation in a timely manner.
- Perform additional duties as identified and directed by management.
- Maintain reliable and predictable attendance during scheduled work hours.
- Utilizes AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopts new technologies as trained and applies them in alignment with established processes and guidelines.
- Demonstrates a customer-first mindset by developing a broad and deep (where appropriate) understanding of Paradigm organization, products, operations, and customers. Prioritizes collaboration to meet customer needs and expectations and takes personal accountability for service quality.
- 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.
QUALIFICATION REQUIREMENTS:- Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience.
- 3 to 5 years of experience in Healthcare Administration, Network Development, Managed Care, and/or Provider Services.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
- Ability to maintain attendance to support required quality and quantity of work.
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
- Superior interpretation and research skills to readily identify problems, get to the root cause and achieve prompt resolution to problems and issues including analytical skills
- Ability to organize, coordinate, and accomplish a high volume of work with minimum impact on quality
- Exceptional interpersonal relations skills.
- Superior verbal and written communication skills.
- Knowledge of Excel and Word.
- This position may require up to 10% travel.
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.
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