Provider Relations Representative, Consultant Job at Blue Shield of California
Your Role
The Specialty Networks & Vendor Management team is responsible for the state-wide behavioral health program at Blue Shield. This includes managing a directly contracted behavioral health provider network, as well as an external vendor and its provider network. The Provider Relations Representative, Consultant will report to the Director. 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.
Your Work
In this role, you will:
- 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 Blue Shield 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
- Provide guidance, coaching, and training to other employees within the job area
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