Provider Relations Representative, Senior

JOB DESCRIPTION
Your Role

The Provider Relations team serves as the intermediary between Blue Shield of California and the IPA/medical groups, hospitals, and PPO physicians in which they are responsible for maintaining long-term relationships with. The Provider Relations Representative, Senior is responsible for building and maintaining effective Provider Relationships with IPA/medical groups, PPO physicians, and hospitals for all lines of business. This role entails delivering established quantifiable goals and targets for an assigned provider network of providers and services the designated provider network in operational and compliance aspects of provider contracts. Reporting to the Sr. Manager, Provider Services, this role will work with providers and internal constituents to resolve service issues promptly and effectively. The ability to present in group settings, and independently drive issues to resolution as well as multi-tasking skills are critical for success.

Your work:

In this role, you will:

• Implement strategies with providers to improve provider performance
• Customize special education needs for providers and deliver strategic communications to assigned providers with minimal guidance
• Coordinate escalated claim disputes and all necessary research in a timely and effective way
• Implement or support at least three geo-regional strategies with minimal support and guidance from the manager
• Coordinate data extracts and data analysis interpretation in preparation of reports to determine the necessity of rate increases to retain key PPO providers, with minimal support and guidance from the manager
• Conduct data-driven operations meetings with an assigned provider network, including IPA/medical groups, PPO providers/provider groups, and hospitals. Demonstrate the ability to drive critical discussions with an assigned network of providers to deliver established quantifiable goals and targets
• Support assigned provider book of business in a customer-focused, effective, and efficient manner
• Develop and maintain deep and long-lasting relationships with providers
• Drive focused strategic outreach with Providers to ensure compliance with Accessibility and Availability within state and federal regulations are met
• Implement strategies with providers to improve provider performance. Customize special education needs for providers and deliver strategic communications to assigned providers with a good level of self-reliance
• Execute crucial provider performance metrics by demonstrating quantifiable improvements that contribute to Blue Shield of California’s critical strategic goals, including but not limited to reducing network utilization to decrease the overall cost of healthcare

QUALIFICATIONS
Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years of prior relevant experience
• Strong organizational and time management skills
• Ability to manage multiple initiatives
• Knowledge of Provider Networks in California
• Appropriate delegation and oversight
• Knowledge of regulatory requirements is preferred

Pay Range:

The pay range for this role is: $77,990.00 to $116,930.00 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.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

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.