Provider Relations Representative, Senior

About the role

The Provider Relations team oversees provider relationships and serves as the primary liaison between Blue Shield of California (BSC) and our contracted provider network. Our role is to support providers through education, issue resolution, and operational guidance, enabling them to effectively navigate our processes and consistently deliver high-quality care to our members.

Responsibilities

• Implement strategies with providers to improve provider performance
• Customize special education needs for providers as well as delivering strategic communications to assigned providers with minimal guidance
• Coordinate escalated claim disputes and all necessary research timely and effectively
• Implement or support at least three geo-regional strategies with minimal support and guidance from your manager
• Coordinate data extracts and data analysis interpretation in preparation of reports aimed at determining the necessity of rate increases to retain key PPO providers, with minimal support and guidance from manager
• Conduct data driven operations meetings with assigned network of providers which includes IPA/medical groups, PPO providers/provider groups and Hospitals
• Drive critical discussions with assigned network of providers to deliver established quantifiable goals and targets
• Serve as the primary point of contact for assigned provider book of business in a customer-focused, effective and efficient manner
• Drive focused strategic outreach with Providers to ensure compliance with Accessibility and Availability within state and federal regulations are met
• Emphasize on improving member’s experience and perception in Getting Needed Care and Getting Care Quickly to help achieve Blue Shield of California’s (BSC’s) mission to meet a Medicare STAR 4 (or better) rating
• Implement strategies with providers to improve provider performance
• Customize special education needs for providers as well as delivering strategic communications to assigned providers with good level of self-reliance
• Execute on key provider performance metrics by demonstrating quantifiable improvements that contribute to BSC's critical few strategic goals, including but not limited to reducing Out of Network utilization to decrease the overall Cost of Healthcare

Qualifications

• Requires a college degree or equivalent experience
• Requires 5 years of prior relevant experience working in Provider Relations across multiple lines of business, including strong provider engagement and relationship management
• Strong organizational and time management skills
• Ability to manage multiple initiatives
• Ability to present in group settings
• Ability to independently drive issues to resolution and multi-task
• Knowledge of Provider Networks in California
• Knowledge of regulatory requirements is preferred
• Knowledge of delegation and oversight

Benefits

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.

Pay

Pay Range for California: $81,950.00 to $122,870.00
Pay Range for Bay Area: $92,380.00 to $138,508.00

Schedule

Full time
Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Locations

• Long Beach, CA, United States
• San Diego, CA, United States
• Woodland Hills, CA, United States