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

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.

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.
• Follows attendance and time off guidelines in accordance with the employee handbook.

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 adopt 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 Management, INC is an Equal Opportunity Employer. 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 require reasonable accommodation in completing the online application process, please email: recruiting@askallegiance.com for support.