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    • Provider Relations Representative, Consultant - San Diego - Blue Shield of CA

    Blue Shield of CA
    Blue Shield of CA San Diego

    1 month ago

    Default job background
    Description

    The Provider Relations Consultant role is a key part of our team at Blue Shield of California. We're seeking a skilled professional to support our CalPERS line of business programs, including Plan to Plan operations.

    This position plays a vital role in building and maintaining effective provider relationships with IPA/medical groups, PPO physicians, and hospitals for all lines of business.

    Main Responsibilities:

    • Develop and implement strategies to improve provider performance.
    • Maintain good working relationships with the provider community.
    • Serve as liaison between the company and providers to resolve questions or problems.
    • E nsure provider compliance with company policies and contractual agreements.
    • Identify potential network participants and promote provider participation in Blue Shield programs and networks.
    • Conduct provider orientations and communicate company policies and procedures.
    • Aid with provider negotiations and manage complex provider relationships.

    Requirements:

    • College degree or equivalent experience required.
    • At least 7 years of prior relevant experience.
    • Minimum 3 years of prior relevant experience in Provider Relations.
    • Excellent analytical and critical thinking skills preferred.
    • Ability to build strong relationships internally and externally.
    • Knowledge of the provider contracting process preferred.

    Pay Range:

    $96,470.00 - $144,760.00 per year, based on location (California, Bay Area, or outside California).

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