Provider Relations Representative, Senior - Behavioral Health Call Center

Blue Shield of California•Rancho Cordova, CA

4d•Remote

About The Position

The Provider Relations Representative, Senior is part of Blue Shield of California’s Behavioral Health Network Management team, which manages the statewide behavioral health program and a directly contracted behavioral health provider network. Reporting to the Behavioral Health Provider Relations Manager, this role supports providers and helps reimagine behavioral health services for Commercial, Medicare, and Medi-Cal members. The position combines provider support, issue resolution, relationship building, and administrative coordination to provide a seamless provider experience. The role works in a call center environment, handling high volumes of provider calls and emails while resolving inquiries, maintaining interaction records, supporting contracting and enrollment processes, and coordinating with internal teams. The position is virtual full-time, with office attendance based on business need.

Requirements

Bachelor’s degree, or a high school diploma/GED plus four years of additional relevant experience in lieu of a degree.
Five years of prior relevant experience in a managed care setting and regularly interacting with providers by phone.
Excellent written and verbal communication skills.
Strong analytical, time management, and organizational skills.
Strong customer service and problem-solving skills.
Proficiency in Outlook, Word, Excel, and Adobe Acrobat.
Ability to work independently and as part of a team; self-starter.

Responsibilities

Answer a high volume of incoming provider calls throughout the workday through an assigned call queue.
Respond to a high volume of provider emails in a group mailbox.
Handle general inquiries, complaints, and concerns professionally and promptly, providing accurate and helpful information.
Escalate complex or unresolved issues to the appropriate department or manager.
Maintain detailed call records and log provider interactions in the system.
Build and maintain relationships with providers to resolve questions or problems, including those involving contract interpretation and product or 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 BSC programs and networks.
Assist with provider negotiations and negotiate selected agreements as applicable.
Conduct orientations, training, and education for providers as needed.
Collaborate with project teams to send contracting packets.
Prioritize work in dedicated project mailboxes based on current business needs.
Receive and process contracting documents, ensuring completeness, accurate tracking, and required reporting.
Contact providers to obtain missing information and documentation as needed.
Screen Medi-Cal and Medicare enrollment and credentialing status.