Medical Review Tech

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