Record Examiner Jobs (NOW HIRING)

THE POSITION As a Medical Records Examiner with the Department of Human Services (DHS), you will play a key part in maintaining the standards of medical services across the state. This position gives you the chance to use your clinical background while supporting the fair use of Medical Assistance resources. You will help identify discrepancies, promote compliance, and conduct reviews of provider practices.

This role provides a rewarding way to make a difference in public service. DESCRIPTION OF WORK This position reviews and evaluates medical services provided under the Medical Assistance Program to help ensure that care meets required standards. The work supports the detection of potential fraud, waste, and abuse while maintaining program integrity.

As a Medical Records Examiner, you will perform the following duties: Case Review: Examine medical records, claims, and related documents to identify issues with compliance or quality of care Data Analysis: Evaluate provider invoicing patterns and service histories to detect irregularities Case Coordination: Organize review steps, track progress, and keep supervisors informed of case developments Report Preparation: Write clear summaries of findings, methods, and recommendations for administrative action Meetings and Testimony: Participate in discussions with supervisors and legal staff and provide testimony when required Provider Communication: Respond to tips, complaints, and referrals from various sources and document actions taken 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

Free parking Telework: You may have the opportunity to work from home (telework) part-time, up to three 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. 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 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 be in possession of 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.

How to Apply: Resumes, cover letters, and similar documents will not be 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. All application materials and interview responses must reflect the applicant's own experience, qualifications, and work. Applicants may use generative AI tools for preparation purposes only.

Use of AI to misrepresent or falsify information, or to assist during interviews, is not permitted. Review the Guidance for Generative AI Tools & Job Seekers for additional information. 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.