Medical Review Technician

This is a fully remote position, open to applicants in Montana.

📋 Description

• Oversee daily task assignments.

• Provide assistance with incoming faxes.

• Organize the receipt and entry of pretreatments and/or pre-certification requests.

• Ensure the accuracy of CPT and ICD coding.

• Communicate effectively with attending and servicing providers to gather complete and precise information.

• Upload and track external reviews sent to external review companies.

• Correspond with external review companies as needed.

• Conduct quality control checks on review responses.

• Accurately process review determinations within required timeframes.

• Collaborate with the clinical team as required.

• Document information 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 any issues.

• Initiate Case Management referrals when necessary.

• Engage in team meetings, committees, or assigned committee roles.

• Receive and communicate messages to the appropriate individuals.

• Contribute to daily operations through regular and timely attendance.

⛳️ Requirements

• High school diploma or GED is mandatory.

• Experience in medical terminology and medical coding is preferred.

• Strong oral and written communication skills are essential.

• Proficient PC skills, including knowledge of Windows and Word.

• Ability to learn and utilize claims processing software for claims processing and adjudication.

• Capacity to adapt to changes in software.

• Understanding of medical terminology and basic health insurance concepts.

• Excellent listening skills.

• High interpersonal skills to collaborate effectively with others.

• Ability to organize and retain large volumes of detailed information.

• Competence in reading, analyzing, and interpreting benefit summary plan descriptions, insurance documents, plan benefits, and regulations, and applying them to specific scenarios.

• Ability to identify errors and make necessary corrections.

• Capability to project a professional image and maintain a positive attitude.

• Compliance with privacy and confidentiality standards is essential.

• Flexibility to work under pressure and meet deadlines.

• Skills in analyzing and solving problems, exercising good judgment, and making decisions.

• Proficiency in operating standard office equipment.

• General knowledge of office procedures.

• Ability to meet standard deadlines and timelines for appeals and reviews.

• Basic mathematical skills are required.

🏝️ Benefits

• Opportunity for a work-at-home arrangement.

• Requirement for internet connection: cable broadband or fiber optic service with a minimum of 10Mbps download and 5Mbps upload speeds.

• Tobacco-free policy; a qualifying smoking cessation program may allow employment in applicable states.