Remote Medical Records Examiner: Coding & Claims Analysis

Commonwealth-of-Pennsylvania; Harrisburg (Dauphin County); Hybrid; 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

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.