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The Medical Review Technician is responsible for coordinating and collaborating in the medical review process. This role requires providing courteous and prompt preparation and responses for all referrals.

Professional communication with peers, supervisors, subordinates, vendors, customers, and the public is essential, along with maintaining a respectful and courteous demeanor in all interactions.

ESSENTIAL JOB FUNCTIONS

• Manages daily work assignments.
• Understands general medical terminology.
• Assists in managing incoming faxes.
• Coordinates the receipt and entry of pretreatments and/or pre-certification requests.
• Ensures accurate coding using CPT and ICD codes
• Communicates with attending/servicing providers to obtain complete and accurate information.
• Uploads and monitors external reviews sent to external review companies.
• Corresponds with external review companies as necessary.
• Preforms quality controls on review responses for accuracy and completeness.
• Accurately processes review determinations in required timeframes.
• Coordinates with clinical team as necessary.
• Documents in Care Management Platform with accuracy and timeliness.
• Facilitates and schedules Peer-to-peer requests.
• Reviews accuracy of member account in Care Management platform and reports as necessary.
• Initiates referrals for Case Management when appropriate.
• Participates in team meetings, committees, or committee assignments.
• Receives and relays communications to the appropriate parties in a timely manner.
• Contributes to the daily workflow with regular and punctual attendance.

REQUIREMENTS

Minimum Education: High school graduation or GED required.

Minimum Experience: Medical terminology and medical coding experience preferred.

Other Qualifications:

• Excellent oral and written communication skills required.
• PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
• Knowledge of medical terminology and basic health insurance concepts.
• Excellent listening skills.
• High level of 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 make appropriate applications to specific situations.
• Ability to identify errors/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 with professionalism and patience, and to 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.

About Allegiance by Cigna Healthcare

Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high-touch approach to member and client service, Allegiance supports some of the nation's most innovative health benefit strategies.

About Cigna Healthcare

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.