Job Description
Cigna Healthcare is seeking a Virtual Medical Review Specialist to join our team remotely. In this role, you will play a crucial part in ensuring the accuracy and compliance of medical documentation and claims by conducting thorough medical reviews. Working from home, you will collaborate with healthcare providers, internal teams, and other professionals to evaluate medical records and ensure that healthcare services meet regulatory and company standards. You will contribute to improving the quality and efficiency of the healthcare delivery process, enhancing the patient experience and outcomes.
Key Responsibilities:
- Review and analyze medical records and claims to verify their accuracy and compliance with Cigna policies, guidelines, and regulatory standards.
- Collaborate with healthcare providers, clinical teams, and internal stakeholders to gather necessary information and resolve discrepancies in medical documentation or claims.
- Conduct thorough assessments of medical necessity and ensure that services rendered align with clinical guidelines.
- Maintain accurate records of reviewed cases, noting recommendations, outcomes, and any follow-up required.
- Identify trends and provide feedback to management regarding potential areas for process improvement.
- Ensure that all medical reviews comply with HIPAA and other healthcare regulations to maintain patient confidentiality and data integrity.
- Assist with training and mentoring new staff on medical review processes, providing guidance as needed.
- Stay updated on healthcare industry regulations, changes in policies, and best practices to ensure the quality of medical reviews.
Required Skills and Qualifications:
- Strong understanding of medical terminology, clinical guidelines, and healthcare regulations.
- Exceptional attention to detail, ensuring the accuracy and integrity of medical reviews.
- Proficient in reviewing medical records and claims, with the ability to interpret complex clinical data.
- Strong communication skills, both written and verbal, with the ability to collaborate effectively with healthcare professionals and internal teams.
- Ability to work independently in a remote environment, manage tasks efficiently, and meet deadlines.
- Proficiency with electronic health records (EHR) systems and other relevant healthcare software.
- Knowledge of HIPAA and other privacy regulations and the ability to maintain patient confidentiality.
Experience:
- Prior experience in medical review, clinical documentation, or a related healthcare role is required.
- Experience working with insurance claims or medical coding is highly beneficial.
Working Hours:
- Full-time, remote position with flexible working hours.
- Occasional evening and weekend shifts may be required to meet operational needs.
Knowledge, Skills, and Abilities:
- Comprehensive understanding of medical record review processes, clinical guidelines, and the medical claims lifecycle.
- Strong analytical skills with the ability to identify trends and inconsistencies in medical data.
- Ability to work effectively in a remote environment, exercising independence and managing time efficiently.
- Excellent interpersonal skills and the ability to maintain professional relationships with healthcare providers and internal teams.
- Ability to handle confidential information with discretion and integrity.
Benefits:
- Competitive salary and incentive programs based on performance.
- Comprehensive health, dental, and vision insurance coverage.
- Paid time off (PTO), holidays, and sick leave.
- 401(k) retirement savings plan with employer contributions.
- Wellness programs including mental health support, fitness reimbursement, and access to resources for a balanced work-life lifestyle.
- Opportunities for professional growth and development within Cigna diverse and inclusive work environment.
Why Join Cigna Healthcare:
- Become a key player in an organization committed to improving healthcare outcomes and patient satisfaction.
- Enjoy the flexibility of working remotely while making an impact on the quality and integrity of medical reviews.
- Be part of a dynamic, supportive team that fosters professional growth and encourages innovation.
- Work for a globally recognized company with a reputation for excellence in healthcare and customer service.
How to Apply:
To apply for the Virtual Medical Review Specialist – Work from Home position, please visit Cigna Careers to submit your resume and cover letter. Cigna encourages all applicants, regardless of background or identity, to apply for this opportunity and join a diverse, inclusive team dedicated to transforming healthcare.
Job Details
- Salary: $10 - $26
- Job Type: Full-time
- Remote/Onsite: Remote
- Location:
Dallas, Texas
- Last Apply Date: 2025-03-22