Provider Relations Representative, Consultant

2 months ago

Redding, United States Blue Shield of CA Full time

Your Role

The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationship necessary to provide our members and clients with access to quality, affordable health care services. The Provider Relations Consultant will report to the Provider Relations, Senior Manager. In this role you will support Blue Shield of California's CalPERS line of business programs, including supporting Plan to Plan operations.

*This is a Short-term Employment (Temporary/Full-Time) role.

Your Work

In this role, you will:

  • Implement strategies with providers to improve provider performance.
  • Develop and keep good working relationships with the provider community.
  • Serve as liaison between the company and the provider community to resolve questions or problems such as contract interpretation, product/program implementation, and claims administration.
  • Ensure provider compliance with company policies and contractual agreement.
  • Identify potential network participants and promote provider participation in Blue Shield of California programs and networks to increase and enhance the company's competitive position in the marketplace.
  • Conduct provider orientations, communicating company policies, procedures, products, or services.
  • Aid with provider negotiations and may negotiate selected agreements.
  • Manage complex provider relationships and function as the primary contact while showing the ability to influence providers and build a strong provider relationship
  • Represent Network Management at internal meetings and present and communicate on behalf of Network Management to stakeholders and/or Network Management leadership
  • Collaborate with various functional areas, influence providers, be a collaborator, interact with different stakeholders of the organization and cultivate business relationships with various constituents


Qualifications and Experience

  • Requires a college degree or equivalent experience and minimum 7 years of prior relevant experience
  • Requires excellent analytical and problem-solving skills.
  • Requires deep knowledge of job area typically obtained through advanced education combined with experience.
  • Viewed as a specialist within discipline. May have broad knowledge of project management.
  • Requires a minimum of 3 years of Provider Relations experience
  • Requires experience in provider outreach
  • Requires the ability to build strong relationships both internally and externally
  • Requires strong written and verbal communication skills
  • Knowledge of provider contracting process is preferred
  • Experience of onboarding providers is preferred.
  • Ability to manage multiple projects is preferred

Pay Range:

The pay range for this role is: $ 96470.00 to $ 144760.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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