Provider Relations Representative, Senior

Are you an experienced healthcare professional looking for an opportunity to develop your career and make a difference? Blue Shield of California is seeking a talented Senior Provider Relations Representative to join our team. In this critical role, you’ll use your expertise in healthcare as well as your strong interpersonal and problem-solving skills to ensure that our members receive the highest level of service. To be successful in this role, you’ll need a minimum of three years of experience in provider relations, health care operations, and/or managed care. You should have a working knowledge of healthcare operations, billing, and healthcare contract language. Additionally, we’re looking for someone who is a strategic thinker, adept at problem-solving, and who has excellent communication and customer service skills. If you have a passion for healthcare and are looking for a role that is both challenging and rewarding, then we’d love to hear from you.

Responsibilities:

1. Develop and maintain relationships with providers, as well as internal and external stakeholders.
2. Negotiate and interpret healthcare contracts and language.
3. Resolve provider issues and complaints in a timely manner.
4. Monitor and analyze provider performance metrics and data.
5. Collaborate with other teams to ensure optimal member experience.
6. Work with providers to develop innovative solutions and strategies to improve care delivery and cost containment.
7. Develop and implement new provider network initiatives.
8. Educate providers on current healthcare policies and procedures.
9. Ensure compliance with applicable state and federal regulations.
10. Maintain up-to-date knowledge of healthcare industry trends.

According to JobzMall, the average salary range for a Provider Relations Representative, Senior in Fresno, CA, USA is between $60,000 and $80,000. The salary range typically depends on experience, qualifications, and the size of the organization. Generally, those with more experience and qualifications may earn higher salaries. Additionally, larger organizations tend to offer higher salaries than smaller organizations.

Blue Shield of California is a health plan provider founded in 1939 and based in Oakland, California. The organization serves over 4 million health plan members and nearly 65,000 physicians across the state. Blue Shield of California was founded by the California Medical Association.