Medical Records Examiner

Full Job Description

Are you a detail-oriented healthcare professional who enjoys analyzing complex medical records and documentation? If so, consider starting a new chapter in your career with the Department of Labor and Industry as a Medical Records Examiner. In this position, you will play a key role in determining appropriateness of medical treatment and its conformity with the Pennsylvania Workers' Compensation Act. If you have a knack for spotting inconsistencies and ensuring accuracy, we have the perfect opportunity for you!

Requirements

As a Medical Records Examiner, you will be responsible for conducting utilization reviews.

This involves evaluating medical information, records, and reports to assess the necessity and appropriateness of care and services provided to State Workers’ Insurance Fund (SWIF) covered individuals.

Work also includes assessing care or treatment plans; providing authorization for services, medications, or durable medical equipment; and verifying codes associated with claims, determining which diagnoses are related to the work injury.

You will have the opportunity to network with other SWIF divisions such as claims services, legal, and fraud as well as external organizations such as pharmacy benefit managers, contractors, and third-party administrators.

Additional responsibilities include:

• Reviewing medical bills to evaluate compensability of services and appropriate payment amounts
• Monitoring medical management reports and nursing care plans
• Providing assistance and direction to field office staff
• Utilizing standard office applications and SWIF specific systems, such as the Workers’ Compensation Automation and Integration System (WCAIS)

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 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.

Telework: You may have the opportunity to work from home (telework) part-time.

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 Scranton. The ability to telework is subject to change at any time.

Additional details may be provided during the interview.

• 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

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:

• This position requires active authorization to practice as a Registered Nurse in Pennsylvania.
• 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:

• Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.

Telecommunications Relay Service (TRS):

• 711 (hearing and speech disabilities or other individuals).

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.

Additional Information

• 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.