Medical Review Technician

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

📋 Description

• Facilitate and collaborate in the medical review process.

• Provide prompt and courteous preparation and responses for referrals.

• Oversee daily work assignments.

• Assist in handling incoming fax communications.

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

• Ensure accurate coding utilizing CPT and ICD codes.

• Engage with attending/servicing providers to gather complete and precise information.

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

• Communicate with external review companies as required.

• Conduct quality controls on review responses to ensure accuracy and completeness.

• Process review determinations accurately within designated timeframes.

• Collaborate with the clinical team as needed.

• Accurately and timely document 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 relevant parties in a timely manner.

• Contribute to daily workflow through regular and punctual attendance.

⛳️ Requirements

• A high school diploma or GED is required.

• Preference for candidates with medical terminology and medical coding experience.

• Excellent oral and written communication skills are essential.

• Proficient PC skills, including familiarity with Windows and Word.

• Ability to learn claims processing software and adapt to software updates.

• Knowledge of medical terminology and fundamental health insurance concepts.

• Exceptional listening skills.

• Capability to organize and recall extensive amounts of detailed information.

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

• Skill in identifying errors/oversights and implementing corrections.

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

• Adherence to privacy and confidentiality standards is crucial.

• Flexibility to work under pressure and meet deadlines.

• Proficient in analyzing and resolving problems, exercising sound judgment.

• Competence in operating standard office equipment.

• Working knowledge of general office practices.

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

• Basic mathematical abilities are required.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits available starting on the first day.

• Access to well-being and behavioral health programs.

• Participation in a 401(k) plan.

• Company-paid life insurance coverage.

• Tuition reimbursement options.

• Minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence available.

• Remote work arrangements offered.

• Requirement for cable broadband or fiber optic internet service with a minimum speed of 10Mbps download/5Mbps upload for home working.