Provider Relations Representative, Consultant (Short Term Employment)

at  Blue Shield of California

QUALIFICATIONSQUALIFICATIONS 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

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.

JOB DESCRIPTIONYOUR 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.

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 constituent