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 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 constituents

Your Knowledge and Experience

• Requires a college degree or equivalent experience.
• Requires 7 years of prior relevant experience.
• Minimum 3 years of prior relevant experience in Provider Relations
• Excellent 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.

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