Medical Review Technician

Job not on LinkedIn

🔥 16 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • 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

• Coordinate and collaborate in the medical review process • Provide courteous and prompt preparation and responses for referrals • Manage daily work assignments • Assist in managing incoming faxes • Coordinate receipt and entry of pretreatments and/or pre-certification requests • Ensure accurate coding using CPT and ICD codes • Communicate with attending/servicing 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 for accuracy and completeness • Process review determinations accurately within required timeframes • Coordinate with the clinical team as necessary • Document accurately and timely in the Care Management Platform • Facilitate and schedule peer-to-peer requests • Review member account accuracy in the Care Management platform and report as necessary • Initiate referrals for Case Management when appropriate • Participate in team meetings, committees, or committee assignments • Receive and relay communications to appropriate parties in a timely manner • Contribute to 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 • 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 • High 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 and apply them to specific situations • Ability to identify errors/oversights and make corrections • Ability to project a professional image and positive attitude • Ability to comply with privacy and confidentiality standards • Ability to work flexibly under pressure and meet deadlines • Ability to analyze and solve problems, exercise good judgment, and make decisions professionally • Ability to operate typical office equipment • Working knowledge of general office procedures • Ability to meet standard deadlines and timelines for appeals and reviews • Basic mathematical skills • Required internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload when working from home

🏖️ Benefits

• Remote work arrangement • Work-from-home internet service requirement supported by cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload • Tobacco-free policy • Reasonable accommodation assistance for the online application process