Medical Review Technician

Job not on LinkedIn

🔥 13 hours ago

🦬 Montana – Remote

🦬 Montana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Manage daily work assignments • Assist with incoming faxes • Coordinate receipt and entry of pretreatments and pre-certification requests • Ensure accurate CPT and ICD coding • Communicate with providers to obtain complete and accurate information • Upload and monitor external reviews sent to external review companies • Correspond with external review companies as necessary • Perform quality controls on review responses • Process review determinations accurately within required timeframes • Coordinate with the clinical team • Document accurately and promptly in the Care Management Platform • Facilitate and schedule peer-to-peer requests • Review member account accuracy and report issues • Initiate Case Management referrals when appropriate • Participate in team meetings and committees • Receive and relay communications to appropriate parties • Contribute to daily workflow through regular and punctual attendance • Coordinate and collaborate in the medical review process • Prepare courteous and prompt responses for referrals

🎯 Requirements

• High school graduation or GED required • Medical terminology and medical coding experience preferred • Excellent oral and written communication skills • PC skills, including Windows and Word • Ability to learn and adapt to claims processing software changes • Knowledge of medical terminology and basic health insurance concepts • Excellent listening skills • Ability to organize and recall detailed information • Ability to interpret benefit summaries, insurance documents, plan benefits, and regulations • Ability to identify and correct errors • Ability to comply with privacy and confidentiality standards • Ability to work flexibly under pressure and meet deadlines • Ability to analyze and solve problems and exercise good judgment • Ability to operate typical office equipment • Working knowledge of general office procedures • Ability to meet deadlines for appeals and reviews • Basic mathematical skills

🏖️ Benefits

• Remote work option • Home internet requirement: cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload • Tobacco-free policy • Reasonable accommodation support for the application process