Medical Records Examiner

Commonwealth of Pennsylvania; Home (PA); Remote; USD 65,000 - 85,000; Full time

Job summary

Commonwealth of Pennsylvania's Department of Human Services is seeking a Medical Records Examiner to support home and community-based services. This role emphasizes detailed review, collaboration, and regulatory compliance to ensure safe, accurate services for Pennsylvanians.

As a home headquartered position, you will work from a PA-approved location with a standard 8:00 AM–4:00 PM schedule. A PA RN license and at least three years of related experience are required to apply.

Qualifications

• Three years of professional experience in medical assistance, health care services, or human services; or an equivalent combination.
• Active Registered Nurse license in Pennsylvania and maintenance of licensure.
• PA residency required; meet PA residency guidelines.

Responsibilities

• Review critical incidents and identify concerns to support participant health and safety.
• Examine service plans to determine accuracy and alignment with participant needs.
• Evaluate medical documents to determine eligibility and appropriate service options.
• Collaborate with providers and agencies to address service issues and improve outcomes.
• Ensure adherence to OLTL policies, regulations, and waiver requirements.
• Assist with monitoring and developing home and community-based service initiatives.

Education

Registered Nurse (RN) license

Job description

Join the Department of Human Services as a Medical Records Examiner and make a direct impact on the well-being of Pennsylvanians. This role offers a meaningful opportunity to support individuals who rely on home and community-based services. You will help ensure that services are delivered safely, accurately, and with care. This position is a great fit for someone who enjoys detailed review and collaborative problem solving.

This position supports the review and evaluation of critical incidents and service plans for individuals receiving home and community-based services. You will help ensure the accuracy, safety, and appropriateness of services across multiple programs. As a Medical Records Examiner, you will perform the following duties:

• Incident Review: Assess critical incidents and identify concerns to support participant health and safety
• Service Plan Evaluation: Examine service plans to determine accuracy and alignment with participant needs
• Documentation Analysis: Evaluate medical documents to determine eligibility and appropriate service options
• Interagency Coordination: Collaborate with providers and agencies to address service issues and improve outcomes
• Regulatory Compliance: Ensure adherence to OLTL policies, regulations, and waiver requirements
• Program Support: Assist with monitoring and developing home and community-based service initiatives

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.
• Home Headquartered: This position is home headquartered. In order to be home headquartered, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania.
• 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:

• This position requires 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.
• This position requires an active motor vehicle license.

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.