Hybrid Provider Relations Representative, Senior bei Blue Shield of California Group
Blue Shield of California Group · Rancho Cordova, Vereinigte Staaten Von Amerika · Hybrid
- Senior
- Optionales Büro in Rancho Cordova
Your Role
The Specialty Networks & Vendor Management team is responsible for the state-wide behavioral health program at Blue Shield of California. This includes managing a directly contracted behavioral health provider network. In this role of Provider Relations Representative, Senior, 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. Reporting to the Manager, Provider Services-Relations, this role combines 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; 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
Qualifications
Your Knowledge and Experience
- Requires a college degree or equivalent experience
- Requires 5 years of prior relevant experience
- Behavioral Health provider relations experience is preferred
- Proficiency in 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
