Medical Review Technician

Job Summary

The Medical Review Technician is responsible for providing non-clinical and technical support to the Medical Review and Utilization Management Teams. This position will be responsible for providing support for the utilization management teams which includes transferring cases to the appropriate nursing staff, entering Utilization Management determinations in the system, and acting as a resource to both internal and external customers. The Medical Review Technician coordinates and provides administrative support for management and team members. This position is responsible for daily inventories and monitoring/maintenance of claims processing queues.

Essential Functions

• Accesses, reviews and filters professional and facility claims. Conducts independent review of claims and holds to determine if medical review is required. Monitors and distributes claims to maintain corporate standards for timeliness and accuracy along with over-site of claim inventory targets.
• Researches and assesses potential system problems and/or enhancements.
• Creates, reviews and maintains reference documents and provides updates to appropriate staff.
• Act as a resource to internal and external staff. Researches and provides both written and/or oral communication to internal and external customers and providers in a professional manner.
• Provide administrative and technical support. 
• Coordinates the administrative functions regarding reconsideration process/requests and requests for coding audit changes.
• Complete daily claims inventory, collects and prepares data within the document management system and distributes inventory reports to appropriate staff in a timely manner to maintain inventory timeliness and to meet quality standards. 

Knowledge, Skills and Abilities

Communication (Verbal/Written)

Intermediate

Technical/Professional Knowledge and Skills

Intermediate

Collaboration

Basic

Decision Making

Basic

Flexibility and Adaptability

Basic

Problem Solving and Resolution

Basic

 

Education Requirements

Required: Associate's

Preferred: Bachelor's

Field(s) of Study: Healthcare Administration, Business or related field

 

Experience Requirements

Required: Minimum of 3 Years

Preferred: Minimum of 3 Years

Experience Details: Minimum of 3 years of coding, healthcare, insurance, claims processing or related experience is required.

 

Certification, Licensures & Registration Requirements

Title: N/A

State or Agency: N/A

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Other Information

Job Posting Policy 6.05

New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Important Notice: BCBSND has a vaccination protocol in place that requires any employees who physically work in a BCBSND office or whose role requires direct customer contact to be vaccinated against COVID-19. We respect your choice to get vaccinated (or not) and getting vaccinated is not a condition of employment. If you are not vaccinated, you may work remotely if your role allows for it. If your role does not allow for remote work and you are unable to get the COVID-19 vaccine, there is an exception process available that includes a weekly testing regimen.

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 02/11/2022 at 8:00AM CST. No further applications will be considered.