Provider Relations Specialist

Ttile: Provider Relations Specialist
Type;Remote
Location: United States

Job Description:

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.

We’re proud to be recognized—again!  For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch this short video for a brief introduction to Paradigm.

Paradigm is seeking a full-time, fully remote Provider Relations Specialist to join our team.  In this pivotal role, you will leverage your 4+ years of experience in provider relations and contract development to support our provider network strategy, maintain strong relationships, and contribute to cost-effective care solutions. 

Responsibilities 

• Serve as the primary point of contact for providers, managing inquiries, documentation, and negotiation follow-up. 
• Facilitate key provider relationships through monthly reviews, quarterly business reviews (QBRs), and annual stewardship meetings. 
• Support management of vendor and partner relationships, participating in regular reviews and stewardship activities. 
• Execute and track single case agreements (SCAs), letters of agreement (LOAs), and other provider arrangements. 
• Maintain accurate contract records and provider contact logs; prepare documentation for provider discussions. 
• Coordinate provider onboarding and education related to Paradigm programs and expectations. 
• Monitor vendor deliverables and escalate issues as needed. 
• 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. 
• Identify trends or provider issues based on contract and billing data. 

Qualifications 

• Minimum of 4 years’ experience in provider relations and contract development. 
• Excellent provider-facing and internal communication skills. 
• Strong written and verbal communication abilities. 
• Familiarity with reference-based pricing models, single case agreements, and facility contracting concepts. 
• Solid organizational skills, attention to detail, and ability to multitask. 
• Working knowledge of Workers Compensation fee schedules, CMS methodology, medical coding, and standard billing practices. 
• Ability to manage multiple priorities effectively. 
• Bachelor’s Degree in a relevant field or equivalent work experience. 
• Commercial healthcare experience is strongly preferred. 

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.

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.