Medical Records Examiner

Full Job Description

Are you a registered nurse looking for an exciting opportunity to utilize your professional judgement? The Department of Human Services (DHS), Division of Clinical Review is seeking a motivated Medical Records Examiner. Our team plays a vital role by monitoring compensable services for medical necessity and compliance with regulations. If you are eager to tackle new challenges and ensure millions of Pennsylvanians receive crucial benefits, then this position was made for you. Apply today!

Requirements

As a Medical Records Examiner, you will review and monitor services for Medical Assistance (MA) recipients.

You will ensure that services were medically necessary, determine if an appropriate facility was used, and evaluate if compensable services were approved in accordance with applicable state and federal laws and regulations.

Duties will include:

• Reviewing authorization requests for home health services, advanced radiology services, proton therapy services, and hyperbaric oxygen services for medical necessity
• Performing pre-admission reviews of all elective admissions
• Evaluating medical information given by practitioners and providers
• Approving or denying requests
• Consulting with physicians when medical need for the requested services is unclear
• Notifying practitioners, providers, facilities, and recipients of authorization numbers, reasons for denials, and appeals procedures

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

Work Schedule and Additional Information:

• Full-time employment, 37.5 hours per week
• 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, up to three days per week.

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, PA. 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:

• You must possess 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 Guidelines.
• 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.