Job DescriptionYour RoleThe Behavioral Health Network Management, Healthcare Quality and Affordability team is responsible for the state-wide behavioral health program at Blue Shield of California (BSC). This includes managing a directly contracted behavioral health provider network. The Provider Relations Representative, Senior will report to the Manager, Provider Services - Relations. In this role you will be one of several team members who will be leading the effort to reimagine how we deliver behavioral health services to our Commercial, Medicare, and Medi-Cal membership. This role combines provider support, issue resolution, relationship building, and administrative coordination to ensure a seamless provider experience.
ResponsibilitiesYour WorkIn this role, you will:
- Answer high volumes of incoming provider calls and emails in a timely and professional manner
- Greet callers warmly and provide accurate, helpful information
- Handle general inquiries, complaints and concerns with poise and diplomacy
- Escalate complex or unresolved issues to the appropriate department or manager
- Maintain detailed call records and log provider interactions in the system
- Develop and maintain good working relationships with the provider community to resolve questions or problems such as contract interpretation and product/program implementation
- Ensure provider compliance with company policies, regulatory requirements, and contractual agreements
- Coordinate with project teams to identify potential network participants and promote provider participation in BSC programs and networks
- Assist with provider negotiations; may negotiate selected agreements
- Conduct orientations, training, and education to the provider community as needed
- Collaborate with project teams to send out contracting packets
- Prioritize work in dedicated project mailboxes based on current business needs
- Receive and process contracting documents to ensure completeness, accurate tracking, and required reporting
- Make outreach calls to providers when needed to obtain missing information and documentation
- Perform screenings for Medi-Cal and Medicare enrollment and credentialing status
QualificationsYour Knowledge and Experience- Requires a college degree or equivalent experience
- Requires 5 years of prior relevant experience
- Strong customer service and problem-solving skills
- Strong analytical skills
- Strong time management and organizational skills
- Self-starter who works well independently or with a team
- Excellent written and verbal communication skills
- Proficiency in Outlook, Word, Excel, and Adobe Acrobat
Hybrid Virtual WorkThis role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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