Provider Relations Specialist
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Job Description
Provider Relations Specialist supporting Paradigm’s healthcare provider network strategy, contracts, and vendor relationships. Analyzing billing data and coordinating provider arrangements for cost-effective care.
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 monthly reviews, QBRs, and annual stewardships
- Support management of key vendor and partner relationships, including monthly reviews, QBRs, and annual stewardships
- Support execution and tracking of single case agreements, letters of agreement, 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
- 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
- Assist with identifying trends or provider issues based on contract and billing data
Requirements:
- 4+ years of experience in provider relations and contract development
- Excellent provider-facing and internal communication skills
- Excellent written and verbal communication skills
- Familiarity with reference-based pricing models, single case agreements, and facility contracting concepts
- Solid organizational skills, attention to detail, and multitasking skills
- Strong working knowledge of Workers Compensation fee schedules, CMS methodology, medical coding, and standard billing practices
- Ability to manage multiple priorities effectively
- Commercial healthcare experience strongly preferred
- Bachelor's Degree in appropriate field of study or equivalent work experience
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