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Medical Records Examiner

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Medical Records Examiner

Salary

$66,250.00 - $100,636.00 Annually

Location

Dauphin County, PA

Job Type

Civil Service Permanent Full-Time

Job Number

CS-2025-24965-39570

Department

Department of Human Services

Division

HS Div Prgm Pvdr Anlys

Opening Date

05/08/2025

Closing Date

5/22/2025 11:59 PM Eastern

Job Code

39570

Position Number

00280080

Union

FOP - Lodge 92

Bargaining Unit

G4

Pay Group

ST08

Bureau / Division Code

00211792

Bureau / Division

Bureau of Program Integrity / Division of Program and Provider Compliance

Worksite Address

Commonwealth Tower

Worksite Address

303 Walnut Street, 4th Floor

City

Harrisburg, Pennsylvania

Zip Code

17101

Contact Name

Ricki Paden

Contact Email

[email protected]

+ Description

+ Benefits

+ Questions

THE POSITION

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!

DESCRIPTION OF WORK

As a Medical Records Examiner, you will review records, documents, and claims submitted by enrolled Medical Assistance (MA) providers. You will r eview 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, m aintain 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 (https://careers.employment.pa.gov/pd/PD\_NEOGOV.asp?p=00280080) .

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.

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

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 (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) . For more information on ways to meet PA residency requirements, follow the link (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) and click on Residency.

+ You must be able to perform essential job functions.

How to Apply:

+ Resumes, cover letters, and similar documents willnotbe 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.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans’ Preference tab or contact us at [email protected] .

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.

EXAMINATION 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/testoncefor this posting.

+ Your results will be provided via email.

Learn more about our Total Rewards by watching this shortvideo (https://www.youtube.com/embed/HtcSRnndflc?rel=0) !

See the total value of your benefits package by exploring ourbenefits calculator.

Health & Wellness

We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*

Compensation & Financial Planning

We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.

Work/Life Balance

We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*

Values and Culture

We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.

Employee Perks

Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.

For more information on all of these Total Rewards benefits, please visitwww.employment.pa.gov and click on the benefits box.

*Eligibility rules apply.

01

You must complete the supplemental question(s) below. Failure to provide complete and accurate information may delay the processing of your application or result in a lower-than-deserved score or disqualification. Youmustcomplete the applicationandanswer the supplemental question(s). Resumes, cover letters, and similar documents willnotbe reviewed for the purposes of determining your eligibility for the position or to determine your score. All information you provide on your application and supplemental question(s) is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty. Read the question(s) carefully. Determine and select the option that most closely represents your highest level of experience/training/certification. The option you choose must be clearly supported if requested.

If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions.

If you have general questions regarding the application and hiring process, please refer to ourFAQ page (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) .

+ Yes

02

Do you possess active authorization to practice as a Registered Nurse in Pennsylvania; or do you possess an active temporary permit to practice as a Registered Nurse in Pennsylvania?

+ Yes

+ No

03

If yes, please list the state that issued your license, your license number, and the expiration date. If you answered no to the question above, please type N/A in the box below.

04

How many years of full-time professional experience do you possess in the field of medical assistance, health care services, or human services?

+ 3 years or more

+ 2 but less than 3 years

+ 1 but less than 2 years

+ Less than 1 year

+ None

05

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.

06

How much graduate coursework have you completed in addiction studies; health and risk communication; health care administration/management; health care informatics/information management; health economics; health education; health insurance studies; health leadership; health policy; health sciences; health services; occupational health and safety; occupational therapy; quality, safety and risk management in health care; physical therapy; psychology; public health; social work; speech therapy; or vocational rehabilitation?

If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted.

If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visitingwww.naces.organd clicking the Evaluation Services Link.

For additional information on foreign education credentials, please visithttps://www.employment.pa.gov/Additional%20Info/Pages/default.aspx#q3and click on Other Information. You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted.

+ 60 credits or more

+ 45 but less than 60 credits

+ 30 but less than 45 credits

+ 15 but less than 30 credits

+ Less than 15 credits

+ None

Required Question

Employer

Commonwealth of Pennsylvania

Address

613 North Street

Harrisburg, Pennsylvania, 17120

Website

http://www.employment.pa.gov