Medical Records Examiner

Commonwealth-of-Pennsylvania; Harrisburg (Dauphin County); On-site; USD 54,000 - 75,000; Full time

Benefits offered by this job

Telework up to 3 days per week

Job summary

The Commonwealth of Pennsylvania's Department of Human Services seeks a Medical Records Examiner to review and evaluate medical procedure coding and related information used in the Medical Assistance Program. This role requires careful analysis, clear communication, and sound judgment when working with coding updates, claims data, and program guidelines.

You will contribute to improving systems and procedures that strengthen health services for communities across Pennsylvania.

Qualifications

• Three years of professional experience in medical assistance, health care services, or human services.
• Active Pennsylvania RN license; if you hold a temporary permit, you must obtain licensure within one year.

Responsibilities

• Coding Review: Evaluate procedure codes and related documentation to support fee schedule decisions
• Information Analysis: Assess claims, encounters, and submissions from providers and agencies to form professional judgments
• Team Coordination: Participate in project teams and workgroups and assist in guiding review processes
• Technical Guidance: Provide consultative support to staff and stakeholders on coding, policy, and system procedures
• Process Evaluation: Examine current procedures and contribute recommendations for improvements
• Stakeholder Communication: Collaborate with policy staff in the development of code set updates, related communications, and provider bulletins

Skills

Medical coding

Analytical thinking

Communication

Education

RN license in PA

Job description

Are you interested in using your medical coding expertise to support a major statewide health program? The Medical Records Examiner position with the Department of Human Services offers a meaningful way to support the Medicaid Program. This role allows you to apply your knowledge of medical coding to help ensure accurate and efficient claims processing. You contribute to improving systems and procedures that strengthen health services for communities across Pennsylvania. Your work helps maintain reliable program operations every day. Consider taking the next step in your professional career and bringing your expertise to this important mission!

This position focuses on reviewing and evaluating medical procedure coding and related information used in the Medical Assistance Program. The role requires careful analysis, clear communication, and sound judgment when working with coding updates, claims data, and program guidelines. As a Medical Records Examiner, you will perform the following duties:

• Coding Review: Evaluate procedure codes and related documentation to support fee schedule decisions
• Information Analysis: Assess claims, encounters, and submissions from providers and agencies to form professional judgments
• Team Coordination: Participate in project teams and workgroups and assist in guiding review processes
• Technical Guidance: Provide consultative support to staff and stakeholders on coding, policy, and system procedures
• Process Evaluation: Examine current procedures and contribute recommendations for improvements
• Stakeholder Communication: Collaborate with policy staff in the development of code set updates, related communications, and provider bulletins

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 3 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. 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

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.
• If you possess an active temporary practice permit, you 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.

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.

• 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.