13 days old

Provider Network Representative

Kelly Services
Helena, MT 59626
**Provider Network Representative- Helena, MT**

Kelly Professional & Industrial is currently recruiting for a Provider Network Representative for the nation's largest customer owned health insurance company at their location in Helena, MT.

***Please note, due to the pandemic, the position will start remote but will be onsite at the HELENA, MT location once we are able to return to work.**

Pay rate: $17.93/ hour

Hours: Monday- Friday, 8:00AM- 5:00PM


This is a training position where the incumbent is learning to perform the following functions in a competent manner.

1. Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships, including but are not limited to claims, pricing, or contracts. Assure both parties understand the mechanics of our relationship with these providers and that our various networks are working well for all involved. Record activities in the specific format required by the region and management. Keep management advised of activities and needs accordingly.

2. Assist in providing training and continuing policy education on all facets of operations to provider staff and others as needed. Conduct provider servicing and assist in the development and distribution of appropriate training materials, etc., as needed.

3. Submit reports on service and recruiting activities and other items as required by management.

4. Respond to fee requests from providers.

5. Provide ongoing development of database, reports and statistical analyses of managed care networks. Create, modify and maintain new and existing reports to provide accurate information for both internal and external reporting.

6. Assist with the coordination and resolution of systemic problems and claim issues. Identify problem and research the impact and origin for resolution. Report problem to management and coordinate with either internal staff or the provider to assure resolution.

7. Assist with the review of provider directories for the managed care networks.

8. Develop and maintain a good working relationship with Core Services, Local Medical Directors, and other internal departments. Coordinate with various departments as required for the recruitment, servicing and retention of contracted providers.

9. Establish working relationship with key facilities, physician groups, practice managers, IPAs, PHOs and other essential contacts. Serve as liaison between facilities or provider office staff and various internal departments.

10. Maintain a high level of expertise in pricing arrangements, contract requirements/language, benefits, membership, claims processing, utilization review, etc.

11. Process provider change forms. Maintain tickler system and verify that all changes have been made in the appropriate system.

12. Prepare monthly reports and update provider databases as necessary. Assist with routine and special reporting requirements.

13. Prepare and mail provider orientation packets, provider manuals and application packets.

14. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

15. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

16. Maintain complete confidentiality of company business.

17. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.


+ Bachelor Degree OR 4 years work experience in the health care/insurance industry.

+ 3 years experience in Network Management, Credentialing and/or Customer Service.

+ Understanding of health care contracts, applications and products.

+ Working knowledge of claims processing systems.

+ 3 years experience utilizing a PC.

+ Verbal and written communication skills.

+ Teamwork and problem solving skills.

+ Analytical and organizational skills.

+ Organizational skills and experience meeting deadlines and working well under pressure.

+ Familiar with provider reimbursement methods.

Please apply to this posting or email your resume to for immediate consideration!

**Why Kelly** **** **?**

As a worker today, its up to you to take charge of your career and look for opportunities to learn, grow, and achieve your potential. Helping you find whats next is what were all about. We know whats going on in the evolving world of workjust ask the nearly 500,000 people we employ each year. Connecting with us means getting the support, guidance, and opportunities needed to take your career where you may have never imagined.

**About Kelly** ****

At **Kelly** , were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/nontraditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live. Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.

Kelly is an equal opportunity employer committed to employing a diverse workforce, including, but not limited to, minorities, females, individuals with disabilities, protected veterans, sexual orientation, gender identity. Equal Employment Opportunity is The Law.

Posted: 2020-10-09 Expires: 2020-11-09

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Provider Network Representative

Kelly Services
Helena, MT 59626

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