Provider Relations Representative, Experienced

Provider Relations Representative, Experienced

Your Work

In this role, you will:

• Implement strategies with providers to improve provider performance.
• Coordinate escalated claim disputes and all necessary research timely and effectively.
• Coordinate data extracts and data analysis interpretation in preparation of reports aimed to determine necessity of rate increases to retain key PPO providers, with some support and guidance from peers or manager.
• Work closely with its assigned IPA/Medical Group to ensure it is compliant with Access and Availability requirements.
• Complete Transition and Disengagement Reports required by the Department of Manage Health care when IPAs/Medical Groups or Hospitals submit termination notices.
• Develop and nurture positive relationships with contracted entities including individual practitioners, IPAs and FQHCs.
• Serve as the primary point of contact for providers addressing inquires, resolving issues and ensuring seamless communication.
• Demonstrate resourcefulness and a proactive approach at resolving challenges related to the health plan such as provider relations and contracting.
• Performs miscellaneous job-related duties as requested.

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in , Join us!

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience.
• Requires at least 3 years of prior relevant experience.
• Proven experience in provider relations, healthcare contracting or similar field.
• Excellent communication skills, both written and verbal with the ability to articulate complex concepts concisely.
• Highly organized with the capacity to manage multiple projects and prioritize effectively.
• Demonstrated self-motivation, drive, and the ability to work autonomously while collaborating with the team.
• Resourcefulness, adaptability, and quick learning abilities to thrive in a fast-paced healthcare environment.

Pay Range:

The pay range for this role is: $ 65083.70 to $ 91116.30 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.