Provider Relations Representative, Consultant

Blue Shield of California; California (MO); On-site; USD 70,000 - 90,000; Full time

Job summary

Join a team committed to reimagining behavioral health services at Blue Shield of California. As a Provider Relations Representative, Consultant, you will be a key player in ensuring a seamless provider experience through relationship building and effective communication, combining administrative coordination with strategic outreach. Ideal candidates are proactive individuals with strong analytical and organizational skills who thrive in a dynamic healthcare environment.

Qualifications

• Requires 7 years of prior relevant experience.
• Proficiency in Microsoft Office tools.
• Excellent written and verbal communication skills.

Responsibilities

• Answer high volumes of incoming provider calls in a timely manner.
• Coordinate with project teams and assist with provider negotiations.
• Ensure provider compliance with company policies and contractual agreements.

Skills

Communication

Analytical skills

Time management

Organizational skills

Education

College degree or equivalent experience

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Adobe Acrobat

Job description

Provider Relations Representative, Consultant

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Provider Relations Representative, Consultant

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Your Role

The Specialty Networks & Vendor Management team is responsible for the state-wide behavioral health program at Blue Shield of California (BSC). This includes managing a directly contracted behavioral health provider network. The Provider Relations Representative, Consultant is one of several team members who will be leading the effort to reimagine how we deliver behavioral health services to our Commercial, Medicare, and Medi-Cal membership. Reporting to the Sr. Manager of Provider Contracting, you will combine provider support, issue resolution, relationship building, and administrative coordination to ensure a seamless provider experience.

Job Description

Your Role

The Specialty Networks & Vendor Management team is responsible for the state-wide behavioral health program at Blue Shield of California (BSC). This includes managing a directly contracted behavioral health provider network. The Provider Relations Representative, Consultant is one of several team members who will be leading the effort to reimagine how we deliver behavioral health services to our Commercial, Medicare, and Medi-Cal membership. Reporting to the Sr. Manager of Provider Contracting, you will combine provider support, issue resolution, relationship building, and administrative coordination to ensure a seamless provider experience.

Responsibilities

Your Work

In this role, you will:

• Answer high volumes of incoming provider calls in a timely and professional manner
• Greet callers warmly and provide accurate, helpful information
• Handle general inquiries, complaints and concerns with poise and diplomacy
• Escalate complex or unresolved issues to the appropriate department or manager
• Maintain detailed call records and log provider interactions in the system
• Develop and maintain good working relationships with the provider community to resolve questions or problems such as contract interpretation and product/program implementation
• Ensure provider compliance with company policies, regulatory requirements, and contractual agreements
• Coordinate with project teams to identify potential network participants and promote provider participation in Blue Shield programs and networks
• Assist with provider negotiations, which may include negotiating selected agreements
• Conduct orientations, training, and education to the provider community as needed
• Collaborate with project teams to send out contracting packets
• Prioritize work in dedicated project mailboxes based on current business needs
• Receive and process contracting documents to ensure completeness, accurate tracking, and required reporting
• Make outreach calls to providers when needed to obtain missing information and documentation
• Perform screenings for Medi-Cal and Medicare enrollment and credentialing status
• Provide guidance, coaching, and training to other employees within the job area
  
  

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 7 years of prior relevant experience
• Proficiency in Microsoft Outlook, Word, Excel, and Adobe Acrobat
• Excellent written and verbal communication skills
• Strong analytical skills
• Strong time management and organizational skills
• Self-starter who works well independently or with a team

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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