Provider Relations Representative, Senior

Your Role

The Provider Support team for Claims and Payment Models is a specialized unit within the Network Management and Provider Partnerships organization that is accountable for improving the provider experience and streamlining operations. The Provider Relations Representative, Senior, will report to the Senior Manager. In this role, you will serve as a liaison between the company and the provider community to resolve questions or problems such as contract interpretation, product / program implementation and claims administration. Externally, you will be responsible for assisting providers including Facilities, Large Systems, and Physicians contracted for value-based payment models with escalated claims and payment issues. Internally, you will be responsible for partnering with cross functional teams including Provider Relations, Contracting, Claims, Clinical, Legal & Compliance, Data Analytics, Information Technology, and Innovation to facilitate issue resolution, identify root causes, and deliver operational improvements.

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 5 years of prior relevant experience
• Strong analytical and problem-solving skills
• Requires advanced knowledge of job area typically obtained through advanced education combined with experience
• Fundamental understanding of medical claims, coding and billing process
• Practical knowledge of project management
• Knowledge of Blue Shield of California or similar health care organization
• Excellent verbal and written communication, presentation skills, and the ability to interact professionally with a diverse group of business leaders and subject matter experts
• Advanced skills using Microsoft Excel, Outlook, PowerPoint, and / or Word
• Experience with report management applications such as Tableau, Salesforce and / or other Customer Relationship Management tool preferred
• Demonstrated "systems thinking" ability for innovation and creative development
• Comfortable with taking notes live during meetings that relay accurate and succinct information
• Ability to function independently and produce results that meet standards of quality, timeliness, and acceptability
• Ability to work in a fast-paced environment, with a virtual team and adapt to a culture of learning and innovation
• Ability to travel to meet with providers and various Blue Shield offices as needed

Pay Range :

The pay range for this role is : $80,300.00 to $120,450.00 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.

Salary : $80,300 - $120,450