Medical Review Technician - Cigna Healthcare - Remote

Cigna Healthcare•Montana Work at Home, MT

21h•Remote

About The Position

The Medical Review Technician coordinates and collaborates in the medical review process, preparing and responding to referrals courteously and promptly. The role requires professional, respectful communication with colleagues, supervisors, vendors, customers, providers, and the public. The technician supports daily review workflow, accurately handles documentation and determinations, and coordinates with clinical teams and external review companies. Allegiance by Cigna Healthcare specializes in administering medical benefits, including claims processing, customer service, utilization management, and case management. The position is remote. For work performed at home occasionally or permanently, an internet connection through cable broadband or fiber optic service with speeds of at least 10 Mbps download and 5 Mbps upload is required.

Requirements

High school graduation or GED required.
Excellent oral and written communication skills.
PC skills, including Windows and Word, and ability to learn claims-processing software functions needed for claims processing and adjudication and adapt to software changes.
Knowledge of medical terminology and basic health insurance concepts.
Excellent listening skills.
Strong interpersonal skills and ability to work effectively with others.
Ability to organize and recall substantial 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 or 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 professionally and patiently, exercise good judgment, and make decisions.
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.

Nice To Haves

Medical terminology experience preferred.
Medical coding experience preferred.

Responsibilities

Manage daily work assignments.
Understand and apply general medical terminology.
Assist in managing incoming faxes.
Coordinate receipt and entry of pretreatment and/or pre-certification requests.
Ensure accurate coding using CPT and ICD codes.
Communicate with attending or servicing providers to obtain complete and accurate information.
Upload and monitor external reviews sent to external review companies, and correspond with those companies as needed.
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 promptly in the Care Management Platform.
Facilitate and schedule peer-to-peer requests.
Review member account accuracy in the Care Management Platform and report issues as needed.
Initiate Case Management referrals when appropriate.
Participate in team meetings, committees, and committee assignments.
Receive and relay communications to appropriate parties in a timely manner.
Contribute to daily workflow through regular and punctual attendance.