
Hybrid Provider Relations Representative, Consultant
Blue Shield of California Group · Rancho Cordova, United States Of America · Hybrid
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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.
Your Work
In this role, you will:
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
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
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
Our Workplace Model:
At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
o Member-facing and approved out-of-state roles remain remote.
o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.