Medical Records Examiner

Commonwealth of Pennsylvania • Dauphin County, PA

6d • Hybrid

About The Position

This position focuses on reviewing and evaluating medical procedure coding and related information used in the Medical Assistance Program. The role requires careful analysis, clear communication, and sound judgment when working with coding updates, claims data, and program guidelines. As a Medical Records Examiner, you will perform the following duties: 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.

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.
• Possess active authorization to practice as a Registered Nurse in Pennsylvania. If you possess an active temporary practice permit, you must obtain licensure as a Registered Nurse within the one (1) year period defined by the Pennsylvania State Board of Nursing.
• Meet the PA residency requirement.

Responsibilities

• Evaluate procedure codes and related documentation to support fee schedule decisions
• Assess claims, encounters, and submissions from providers and agencies to form professional judgments
• Participate in project teams and workgroups and assist in guiding review processes
• Provide consultative support to staff and stakeholders on coding, policy, and system procedures
• Examine current procedures and contribute recommendations for improvements
• Collaborate with policy staff in the development of code set updates, related communications, and provider bulletins

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed