Medical Review Technician

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🦬 Montana – Remote

🦬 Montana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Technician

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Responsible for coordinating and collaborating in the medical review process • Providing courteous and prompt preparation and responses for all referrals • Manages daily work assignments • Understands general medical terminology • Assists in managing incoming faxes • Coordinates the receipt and entry of pretreatments and/or pre-certification requests • Ensures accurate coding using CPT and ICD codes • Communicates with attending/servicing providers to obtain complete and accurate information • Uploads and monitors external reviews sent to external review companies • Corresponds with external review companies as necessary • Performs quality controls on review responses for accuracy and completeness • Accurately processes review determinations in required timeframes • Coordinates with clinical team as necessary • Documents in Care Management Platform with accuracy and timeliness • Facilitates and schedules Peer-to-peer requests • Reviews accuracy of member account in Care Management platform • Initiates referrals for Case Management when appropriate • Participates in team meetings, committees, or committee assignments • Receives and relays communications to the appropriate parties in a timely manner • Contributes to the daily workflow with regular and punctual attendance

🎯 Requirements

• High school graduation or GED required • Medical terminology and medical coding experience preferred • Excellent oral and written communication skills required • PC skills, including Windows and Word • Ability to learn all functions of the claims processing software • Must be able to adapt to software changes as they occur • Knowledge of medical terminology and basic health insurance concepts • Excellent listening skills • High level of interpersonal skills to work effectively with others • Ability to organize and recall large amounts of detailed information • Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations • Ability to identify errors/oversights and make corrections • Ability to project a professional image and positive attitude in any work environment • Ability to comply with privacy and confidentiality standards • Ability to be flexible, work under pressure and meet deadlines • Ability to analyze and solve problems with professionalism and patience • Ability to operate typical office equipment • Working knowledge of general office procedures • Basic mathematical skills

🏖️ Benefits

• Professional communication with peers, supervisors, subordinates, vendors, customers, and the public • Maintaining a respectful and courteous demeanor in all interactions • Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.