Provider Relations Representative, Senior

Blue Shield of California•Rancho Cordova, CA

20h•Hybrid

About The Position

The Behavioral Health Network Management, Healthcare Quality and Affordability 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, Senior will report to the Manager, Provider Services – Relations. In this role you will be 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. This role combines provider support, issue resolution, relationship building, and administrative coordination to ensure a seamless provider experience. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

Requires a college degree or equivalent experience
Requires 5 years of prior relevant experience
Strong customer service and problem-solving skills
Strong analytical skills
Strong time management and organizational skills
Self-starter who works well independently or with a team
Excellent written and verbal communication skills
Proficiency in Outlook, Word, Excel, and Adobe Acrobat

Responsibilities

Answer high volumes of incoming provider calls and emails 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 BSC programs and networks
Assist with provider negotiations; may negotiate 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