Medical Review Technician

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $17 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 claims processing software and adapt to software changes • Knowledge of medical terminology and basic health insurance concepts • Excellent listening skills • 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 • 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 standard deadlines and timelines for appeals and reviews • Basic mathematical skills

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement • Cable broadband or fiber optic internet service requirement with speeds of at least 10Mbps download/5Mbps upload for home working