Allegiance Benefit Plan Mgmt.
  • 05-Feb-2021 to Until Filled (MST)
  • Missoula, MT, USA
  • $13.53
  • Hourly
  • Full Time

Full Benefit Package


Do you want a career where you can make a difference? Allegiance is a growing company with hometown values that is looking for dynamic candidates to join the team! A positive, team-oriented environment is provided with opportunities for advancement.

Allegiance offers full-time positions with evenings, weekends, and holidays off and a multi-faceted benefits package.

We pride ourselves in having a reputation for top-notch customer service. Make a difference. Start your career with Allegiance today!

REPORTS TO: Medical Review Manager LOCATION: Missoula FLSA STATUS: Non-Exempt

POSITION RESPONSIBILITIES:

The Medical Review Tech is responsible for the coordination and collaboration of the medical review process. The incumbent is expected to provide courteous and prompt preparation and responses for all referrals.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.

ESSENTIAL JOB FUNCTIONS:

Essential job functions include the following. Other functions may be assigned as business conditions change.

  • Manages daily work assignments.
  • Reviews prior determination requests received from IMR coordinator based on plan language and Cigna polices. All approvals should be properly documented in acuity with an appropriate response letters sent. All denials should be properly distributed to for further review to the Med Review nurse.
  • Able to uploads and monitors external reviews to external review companies
  • Reviews IMR responses for accuracy and completeness and corresponds with review companies as necessary.
  • Coordinates with Med Review nurses to determined accurate documentation and clinical oversight on required reviews.
  • Document all prepared items in Acuity with accuracy and timeliness.
  • Field and set up peer to peer appointments
  • Reviews account for potential needs and reports as necessary.
  • Distributes independent medical review responses appropriately.
  • Documents and conveys decisions with accuracy.
  • Initiate referrals for Case Management when appropriate
  • Sends review responses in required timeframes, including notification to providers and examiners.

Contributes to the daily workflow with regular and punctual attendance.

  • Maintains general clinical knowledge and skills through the attendance of available Internet education or conference calls, written works, or other similar resources.
  • Participates in team meetings, committees, or committee assignments as assigned
  • Initiates and continues direct communication with health care providers involved with the care of the member to obtain complete and accurate information.
  • Ensures accurate coding using CPT-4 and ICD-10 codes and documents all information accurately.
  • Meets service standards for decision turn-around times and written correspondence.

NON-ESSENTIAL JOB FUNCTIONS:

  • Performs related or other assigned duties as required or directed.

SUPERVISION EXERCISED:

None.



PHYSICAL WORKING CONDITIONS:

Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Sitting 80% Reaching Some

Standing 10% Manual Dexterity High

Walking 10% Telephone Yes

Kneeling Some Computer Screen High (visual acuity corrected to 20/30)

Bending Some Lifting up to 20 pounds

JOB SPECIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Minimum Education: High school graduation or GED required. Bachelor's Degree preferred

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.

Typing ability of 45 wpm net.

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.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.


Allegiance Benefit Plan Mgmt.
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