Provider Processor, Advanced

JOB DESCRIPTION
Your Role

The Provider Operations team manages Blue Shield’s network of physicians, IPA/Medical groups, hospitals, and specialty healthcare providers. The Provider Processor, Advanced will report to the Operations Supervisor. In this role you will work independently and demonstrate strong organization and prioritization skills, respond to various provider inquires. Apply standard operating procedures and guidelines. Resolve all inquiries within established timeliness and quality standards. Processors must have the ability to communicate professionally with internal and external customers. As an individual contributor our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.

Your Work

In this role, you will:

• Apply defined procedures and policies to accurately maintain provider file maintenance in the Provider Manager application.
• Complete Provider inquiries or updates related to Blue Shield of California and/or Blue Shield of California Promise Health Plan networks.
• Coordinate with other departments to ensure timely and appropriate responses are completed.
• Communicate with internal/external business partners regarding contractual responsibilities, policies, and procedures.
• Consistently performs established duties that are measurable metrics by internal SLA’s or mandated turnaround times.
• Continually performing research and applying critical thinking, meet or exceed daily goals, while maintaining a high- level quality of work.
• May expedite, research, and resolve complex issues.
• Assists with documentation review and supports questions as needed.
• Considered Subject Matter Expert (SME) in Provider Processing and documentation.
• Solid understanding and knowledge of system processing with the ability to not only identify errors but to analyze and resolve them.

QUALIFICATIONS
Your Knowledge and Experience

• Requires a high school diploma or GED
• Typically, requires minimum of 5 years of experience with above responsibilities. May require vocational or technical education in addition to prior work experience
• Intermediate-Advanced skills creating documents/files using Excel, Outlook, and Word
• Requires broad knowledge of operational systems and procedures obtained through prior work experience or education
• Extensive experience in Provider Manager Systems application
• Competent in processing multiple lines of business
In-depth knowledge of Blue Shield of California’s mission, vision, and strategy as well as healthcare industry environment

Pay Range:

The pay range for this role is: $22.69 to $31.77 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 candidates experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say were going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment – roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.