Medical Records Examiner

Commonwealth of Pennsylvania; Pennsylvania; Hybrid; USD 55,000 - 75,000; Full time

Job summary

The Commonwealth of Pennsylvania seeks a Medical Records Examiner for the Department of Human Services to review clinical, financial, and regulatory data across nursing facilities and ensure compliance with state and federal requirements.

This full-time role requires PA RN licensure, residency, and attention to detail. It operates from a home-based headquarters within PA, with standard daytime hours and a 30-minute lunch.

Qualifications

• Three years of professional experience in medical assistance, health care services, or human services.
• Active RN license in Pennsylvania.
• You must possess an active motor vehicle license.

Responsibilities

• Review clinical, financial, and regulatory information to assess compliance in nursing facilities.
• Perform policy compliance checks to ensure providers meet state and federal requirements.
• Conduct PA-PASRR-ID evaluations and submit recommendations to the appropriate program office.
• Analyze financial records to identify recoveries and support proper billing adjustments.

Skills

Medical experience

Education

PA RN license

Job description

THE POSITION

As a Medical Records Examiner with the Department of Human Services (DHS), you will have a direct impact on the quality of care delivered in nursing facilities across the state. This position gives you the opportunity to apply your expertise every day while strengthening essential compliance efforts. You will collaborate with committed professionals and help ensure that vital services reach the individuals who depend on them. This role is an excellent match for someone who enjoys detailed work and is driven to support strong public service outcomes.

THE POSITION

As a Medical Records Examiner with the Department of Human Services (DHS), you will have a direct impact on the quality of care delivered in nursing facilities across the state. This position gives you the opportunity to apply your expertise every day while strengthening essential compliance efforts. You will collaborate with committed professionals and help ensure that vital services reach the individuals who depend on them. This role is an excellent match for someone who enjoys detailed work and is driven to support strong public service outcomes.

DESCRIPTION OF WORK

This position focuses on reviewing clinical, financial, and regulatory information to assess compliance in nursing facilities throughout the state. As a Medical Records Examiner, you will perform the following duties:

• Clinical Reviews: Evaluate clinical, physical, rehabilitative, and restorative care to determine appropriateness


• Policy Compliance: Review policies and regulations to ensure providers comply with state and federal requirements


• PASRR Evaluations: Conduct assessments of PA Pre-Admission Screening Resident Review (PA-PASRR-ID) positive individuals and submit recommendations to the appropriate program office


• Financial Analysis: Examine financial records to identify recoveries and support proper billing adjustments


• Facility Monitoring: Monitor nursing facility admissions, continued stays, discharge plans, and overall service adequacy


• Technical Support: Provide assistance to nursing facility staff to help them meet compliance requirements

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.


• 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

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

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.


• You must possess 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.

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/test once for this posting.


• Your results will be provided via email.