Medical Records Examiner
2 months ago
**THE POSITION**:
**DESCRIPTION OF WORK**:
In this role, you will act as a case coordinator and review, as well as evaluate, the medical necessity, appropriateness, and adequacy of care and identify discrepancies through the analysis of paid claims, itemized bills, computer reports, medical records, diagnosis coding, and other information. This includes retrospective cases. You will prepare case findings and consult with in-house medical staff to write the necessary letters to providers. You will also prepare other material in the course of the review by writing memoranda, letters, and reports to make case status changes, refer information to other agencies to communicate with providers or carry out necessary review activities. You will participate in meetings with the division director, section supervisor, legal counsel, and other agencies. At these meetings, you will discuss the provider case history, case strategy, and your findings to recommend sanctions in accordance with department guidelines, and to prepare for testifying at administrative hearings or trials in Commonwealth or Federal Court.
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 30-minute lunch.
- ** Telework**:You may have the opportunity to work from home (telework) part-time up to 3 days a 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.
- ** Salary**:_ _**In some cases, the starting salary may be non-negotiable.
**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**:
- This position requires you to have an 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.
**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.
- You must be able to perform essential job functions.
**How to Apply**:
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**Veterans**:
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**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.
**EXAMINATION INFORMATION**:
- 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.
Learn more about our Total Rewards by watching this short video
**Health & Wellness**
We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*
**Compensation & Financial Planning**
We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.
**Work/Life Balance**
We know there’s more to life than just work Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*
**Values and Culture**
We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.
**Employee Perks**
Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.
- Eligibility rules apply.
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