Provider Relations Coordinator

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone. Responsibilities Execute on key provider performance metrics by demonstrating quantifiable improvements that contribute to Company's critical few strategic goals; including but not limited to reducing Out of Network utilization to decrease the overall Cost of Healthcare Drive focused strategic outreach with Providers to ensure compliance with Accessibility and Availability within state and federal regulations are met; Emphasis on improving member's experience and perception in Getting Needed Care and Getting Care Quickly to help achieve Blue Shield's mission to meet a Medicare STAR 4 (or better) rating Conduct data driven operations meetings with assigned network of providers which includes IPA/medical groups, PPO providers/provider groups and Hospitals; Ability to drive critical discussions with assigned network of providers to deliver established quantifiable goals and targets Support assigned provider book of business in a customer-focused, effective and efficient manner External facing position that develops and maintains deep and long-lasting relationships with providers Customize education and trainings to meet the needs of providers as well as effectively delivering it in group settings Coordinate escalated claim disputes and all necessary research timely and effectively which may require some reliance on their manager and senior level peers in setting action plans to analyze and resolve root cause issues Ability to lead ad-hoc projects/assignments and actively drive discussions in all internal and external meetings The job requires high level of autonomy in decision making since PRC's main customers (providers) need to rely on the PRC's for answers to issues that need immediate resolution Qualifications Bachelor's degree strongly preferred. Experience in Provider Relations/Network Management within managed care setting, health care industry or related field is strongly preferred. Local travel within territory is expected. #J-18808-Ljbffr Blue Shield of California