Blue Shield of California
Provider Relations Representative, Consultant
Blue Shield of California, El Dorado Hills, California, United States, 95762
Job Description
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. Provider Relations Consultant handles building and maintaining effective provider relationships with IPA/medical groups, PPO physicians, and hospitals for all lines of business and implementing strategies with providers to improve provider performance. Maintain and develop good working relationships with the provider community. Serves as Blue Shield and the provider community liaison to resolve questions or problems such as contract interpretation, product/program implementation, and claims administration. Ensures provider compliance with company policies and contractual agreements. Identifies potential network participants and promotes provider participation in Blue Shield programs and networks to increase and enhance the company's competitive position in the marketplace. Conducts provider orientations, communicating company policies, procedures, products, or services. Represents Blue Shield at professional associations to promote corporate programs, products, and services.
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 relationshipRepresent Network Management at internal meetings and present and communicate on behalf of Network Management to stakeholders and/or Network Management leadershipCollaborate with various functional areas, influence providers, be a collaborator, interact with different stakeholders of the organization and cultivate business relationships with various constituents
Qualifications
Your Knowledge and ExperienceRequires a college degree or equivalent experience.Requires 7 years of prior relevant experience.Minimum 3 years of prior relevant experience in Provider RelationsExcellent analytical and critical thinking skills are preferred.The ability to build strong relationships both internally and externally.Knowledge of provider contracting process is preferred.Experience of onboarding providers is preferred.Experience in provider outreach.Ability to manage multiple projects is preferred.Effective communication skills
Your Pay
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.
#LI-AG3
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 officeHybrid - In a business unit approved office a few times per year to 3 days per week, on averageOffice - 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.
Please click here for further physical requirement detail.
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.
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. Provider Relations Consultant handles building and maintaining effective provider relationships with IPA/medical groups, PPO physicians, and hospitals for all lines of business and implementing strategies with providers to improve provider performance. Maintain and develop good working relationships with the provider community. Serves as Blue Shield and the provider community liaison to resolve questions or problems such as contract interpretation, product/program implementation, and claims administration. Ensures provider compliance with company policies and contractual agreements. Identifies potential network participants and promotes provider participation in Blue Shield programs and networks to increase and enhance the company's competitive position in the marketplace. Conducts provider orientations, communicating company policies, procedures, products, or services. Represents Blue Shield at professional associations to promote corporate programs, products, and services.
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 relationshipRepresent Network Management at internal meetings and present and communicate on behalf of Network Management to stakeholders and/or Network Management leadershipCollaborate with various functional areas, influence providers, be a collaborator, interact with different stakeholders of the organization and cultivate business relationships with various constituents
Qualifications
Your Knowledge and ExperienceRequires a college degree or equivalent experience.Requires 7 years of prior relevant experience.Minimum 3 years of prior relevant experience in Provider RelationsExcellent analytical and critical thinking skills are preferred.The ability to build strong relationships both internally and externally.Knowledge of provider contracting process is preferred.Experience of onboarding providers is preferred.Experience in provider outreach.Ability to manage multiple projects is preferred.Effective communication skills
Your Pay
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.
#LI-AG3
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 officeHybrid - In a business unit approved office a few times per year to 3 days per week, on averageOffice - 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.
Please click here for further physical requirement detail.
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.