Medical Review Technician - Cigna Healthcare - Remote

The Cigna Group•, MT

19h•Remote

About The Position

The Medical Review Technician coordinates and collaborates in the medical review process, providing courteous and prompt preparation and responses for referrals. The role requires professional, respectful communication with peers, supervisors, subordinates, vendors, customers, and the public. The technician manages incoming review work and requests, supports accurate coding and documentation, communicates with providers and external review companies, and coordinates with the clinical team. The position also helps maintain timely, accurate review determinations and supports referrals for case management when appropriate. Allegiance by Cigna Healthcare administers medical benefits, including claims processing, customer service, utilization management, and case management. For employees working at home occasionally or permanently, an internet connection through cable broadband or fiber optic service is required, with speeds of at least 10 Mbps download and 5 Mbps upload.

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 and adapt to software changes.
Knowledge of medical terminology and basic health insurance concepts.
Excellent listening skills.
Strong 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 and correct errors or oversights.
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, and exercise good judgment when making 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.
For work at home occasionally or permanently, access to cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload speeds.

Nice To Haves

Medical terminology experience.
Medical coding experience.

Responsibilities

Manage daily work assignments.
Assist in managing incoming faxes.
Coordinate the 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 and 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 the accuracy of member accounts in the Care Management Platform and report issues 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 through regular and punctual attendance.