Medical Review Technician

**NO EXPERIENCE NECESSARY- WE WILL TRAIN**

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: UM Supervisor

LOCATION: Allegiance office or off-site

FLSA STATUS: Non-Exempt

*Applicants do not have to reside in Montana but do need to be available for work 8-5 Mountain time.*

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.
• 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.
• Performs 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

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 esse