Medical Review Technician

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

📋 Description

• Overseeing and collaborating in the medical review process.

• Delivering prompt and courteous preparation and responses for all referrals.

• Managing daily work responsibilities.

• Possessing a solid understanding of general medical terminology.

• Assisting in the management of incoming faxes.

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

• Ensuring precise coding using CPT and ICD codes.

• Communicating with attending and servicing providers to gather complete and accurate information.

• Uploading and monitoring external reviews sent to external review companies.

• Corresponding with external review companies as required.

• Conducting quality controls on review responses for accuracy and completeness.

• Processing review determinations accurately within required timeframes.

• Collaborating with the clinical team as needed.

• Documenting in the Care Management Platform with precision and timeliness.

• Facilitating and scheduling Peer-to-peer requests.

• Reviewing the accuracy of member accounts in the Care Management platform.

• Initiating referrals for Case Management when appropriate.

• Participating in team meetings, committees, or committee assignments.

• Receiving and relaying communications to the appropriate parties promptly.

• Contributing to daily workflow with consistent and punctual attendance.

⛳️ Requirements

• High school diploma or GED is required.

• Experience in medical terminology and medical coding is preferred.

• Strong oral and written communication skills are essential.

• Proficiency in PC skills, including Windows and Word.

• Ability to learn all functionalities of the claims processing software.

• Must be adaptable to software changes as they arise.

• Familiarity with medical terminology and basic health insurance concepts.

• Exceptional listening skills.

• High level of interpersonal skills to collaborate effectively with others.

• Capacity to organize and recall extensive detailed information.

• Ability to read, analyze, and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations.

• Proficiency in identifying errors or oversights and making necessary corrections.

• Ability to project a professional image and maintain a positive attitude in any work environment.

• Compliance with privacy and confidentiality standards is required.

• Flexibility to work under pressure and meet deadlines.

• Skill in analyzing and solving problems with professionalism and patience.

• Capability to operate typical office equipment.

• Working knowledge of general office procedures.

• Basic mathematical skills are necessary.

🏝️ Benefits

• Professional communication with colleagues, supervisors, subordinates, vendors, customers, and the public.

• Maintaining a respectful and courteous demeanor in all interactions.

• An internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.