Provider Relations Representative, Senior

Your Role

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.

Your Knowledge and Experience

• 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

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

Your Work

In this role, you will:

• 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

Your Work

In this role, you will:

• 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