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!!

POSITION RESPONSIBILITIES:

The UM-IP Review Tech is responsible for the coordination and collaboration of the Inpatient Authorization 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.

Reviews Inpatient Authorization requests received
Determine if additional information is necessary. Contact provider and obtain additional information.
If medical necessity not met
Prepare package for clinical review
Initiate and continue direct communication with health care providers involved with the care of the member to obtain complete and accurate information.
Review IMR responses for accuracy and completeness and correspond with clinical staff as necessary.
Coordinate with UM-IP Nurses to determined accurate documentation and clinical oversight on required reviews.
Coordinate peer to peer appointments.
Prepare & distribute Inpatient Authorization response letters in required timeframes.
Meets service standards for decision turn-around times and written correspondence
Initiate referrals for Case Management when appropriate
Contributes the daily workflow with regular and punctual attendance.
Maintain general clinical knowledge and skills through the attendance of available Internet education or conference calls, written works, or other similar resources and share knowledge with others
Ensure accurate coding using current CPT and ICD codes and document all information accurately.
Assist in managing incoming fax queue
Initiate and receive phone calls related to Inpatient admissions and continued stay reviews.
NON-ESSENTIAL JOB FUNCTIONS:

Performs related or other assigned duties as required or directed.
SUPERVISION EXERCISED:

None