CenterWatch

26 days old

Provider Network Representative

Kelly Services
Spokane, WA 99207
**Job Description**


Kelly Services is Hiring 10 positions!! Temporary assignment for 10 weeks

You will be doing the following:

- Provide timely, accurate, courteous and concise responses to inquiries, made by provider offices, associates and internal departments related to contracts, payment methods, contract types, claims, communications etc.

- Educate providers and their staff regarding billing, credentialing, contractual requirements, claims and company policies. Present a positive, professional image to providers, peers and all associates. Resolve provider inquiries by investigation/review within department standards/processes.

- Assure compliance with the National Committee for Quality Assurance (NCQA) and other regulatory agencies/requirements. Assure provider issues, as well as inquiries, are accurately documented, initiated and completed. Thoroughly investigate problems/issues by obtaining and/or coordinating information from other internal departments or external organizations. Identify appropriate resource-based relative value scale (RVRBS) schedule and fee schedule rules to determine proper allowed amount.

- Enforce the policies and procedures of Premera and Premera's affiliates. Inform appropriate associates of violations to protocol. Maintain the confidentiality of information relating to our members, providers, contracts and operational protocols.

- Coordinate with PS&S staff, Care Management, Claims, Operations, Credentialing, Provider Contracting, Quality Improvement and/or other departments to answer questions, resolve problems and ensure that plan and department requirements are met. Participate in department staff meetings updating staff on provider issues. Assist Customer Service staff with unusual inquiries and unique provider issues. Maintain accurate and complete electronic and/or hard copy records on all provider correspondence and special cases.

- Provide backup for Provider Network Executives (PNEs) and Provider Network Associates (PNAs) as needed. Perform other duties as assigned.


**Requirements**


Minimum Qualifications:

- Three (3) years' experience in a customer service or related environment.


Preferred Qualifications:

- One (1) year of health insurance industry experience.


Knowledge, Skills and Abilities:

- Knowledge of other internal department operations/functions that assist in resolution of provider inquires, as well as a familiarity with current lines of business and products.

- Knowledge of PS&S operations, policies/procedures and processes.

- Knowledge of contracts, contract types, interpretations and language.

- Knowledge of CPT coding, ICD-10 codes and medical terminology.

- Knowledge or experience in health care industry.

- Knowledge of claims paying system and claims paying procedures.

- Ability to be assertive, professional and compassionate in providing problem resolution for customers.

- Demonstrated flexibility, resourcefulness and ability to perform work independently while being an effective team player.

- Demonstrated effective phone, written and verbal communication skills.

- Demonstrated ability to work effectively cross-functionally in a large organization.

- Proficiency in Windows, Word, Excel and Access.

Please reply WITH RESUME to 6216@kellyservices.com


**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: 2019-10-21 Expires: 2019-11-21

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Provider Network Representative

Kelly Services
Spokane, WA 99207

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast