Medical Records Examiner

Are you a Registered Nurse looking to use your skills to investigate medical program misuse? Do you want to visit providers and conduct reviews of Pennsylvania Medical Assistance Program participants? The Department of Human Services (DHS), Bureau of Program Integrity, is seeking a Medical Records Examiner. If you want to promote health and protect citizens from fraud and abuse, then apply for this exciting opportunity today!

As a Medical Records Examiner, you will review records, documents, and claims submitted by enrolled Medical Assistance (MA) providers. You will review services provided to eligible program beneficiaries to determine if they were medically necessary and billed in accordance with MA, state, and federal regulations. You will also identify invoice discrepancies and analyze claim histories while reviewing medical records and services rendered by providers to detect waste, abuse, and fraud. This role requires strong organizational and analytical skills to submit written documentation of violations as well as effective communication to recommend corrective action. In addition, you will ensure provider licenses and credentials are valid, maintain case tracking information, and testify at administrative, state, and federal hearings and court proceedings.

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 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Free parking
• Telework: You may have the opportunity to work from home (telework) part-time three days and work two days 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 have 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.