Provider Relations Representative, Senior - Behavioral Health Call Center
About The Position
The Provider Relations Representative, Senior works on 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 serving Commercial, Medicare, and Medi-Cal members. It combines call-center provider support, issue resolution, relationship building, and administrative coordination to help ensure a seamless provider experience. The position works in a call-center environment, handling a high volume of provider calls and emails, answering questions, resolving or escalating issues, and documenting interactions. It also supports provider contracting and network participation, processes documents, conducts outreach and provider education, and performs screenings related to Medi-Cal and Medicare enrollment and credentialing. The role allows employees to work virtually full-time, with office attendance based on business needs. The role is based in an office and work-from-home/deskwork environment, with a sedentary activity level for most of the workday.
Requirements
- Bachelor’s degree, or a high school diploma/GED with four years of additional relevant experience in lieu of a degree.
- Five years of prior relevant experience working in a managed care setting and regularly interacting with providers over the 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 as a self-starter and collaborate with a team.
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 working relationships with providers to resolve questions and 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 participation in Blue Shield of California programs and networks.
- Assist with provider negotiations and negotiate selected agreements when applicable.
- Conduct provider orientations, training, and education as needed.
- Collaborate with project teams to send contracting packets.
- Prioritize work in dedicated project mailboxes according to current business needs.
- Receive and process contracting documents, ensuring completeness, accurate tracking, and required reporting.
- Contact providers to obtain missing information and documentation when needed.
- Screen Medi-Cal and Medicare enrollment and credentialing status.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
