Medical Records Examiner

Are you looking for a career opportunity that utilizes your nursing experience to evaluate clinical information? Do you possess attention to detail and a desire to ensure eligible medical assistance recipients receive appropriate urgent and acute medical care? The Department of Human Services (DHS), Division of Clinical Review is looking for a motivated Medical Records Examiner. If you want to use investigative skills to research the medical necessity of resource determinations, this is the job for you! Make a critical difference in your community and apply today!

As a Medical Records Examiner, you will perform admissions reviews for medical assistance recipients. You will evaluate the admissions process to hospitals via emergency rooms, short-term procedure units, and medical rehabilitation hospitals. You will will determine medical necessity of services, appropriate location setting, and compensability of services in accordance with applicable state and federal Medical Assistance (MA) laws and regulations. This role requires the ability to effectively communicate with providers when medical need for the requested setting is unclear. In addition, you will assist with training new staff members, update files to generate decisioning notifications, and explain regulations, operational methods, and administrative procedures to providers.

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 7:30 AM to 4:00 PM, Monday - Friday, with a 60-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time, working a minimum one day per month in the office. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

Minimum Experience and Training Requirements:

• Three years of professional experience in the field of medical assistance, health care services, or human services; or
• An equivalent combination of experience and training.

Special Requirements:

• You must be in possession of active authorization to practice as a Registered Nurse in Pennsylvania.
• All employees possessing an active temporary practice permit must obtain licensure as a Registered Nurse within the one (1) year period defined by the Pennsylvania State Board of Nursing.

Other Requirements:

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency.
• You must be able to perform essential job functions.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.

Veterans:

Telecommunications Relay Service (TRS):

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

• Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
• Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
• Your score is valid for this specific posting only.
• You must provide complete and accurate information or:
  • your score may be lower than deserved.
  • you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.