Medical Records Examiner

Commonwealth of Pennsylvania • Dauphin County, PA

10d • Hybrid

About The Position

Ready to take your nursing expertise beyond the bedside and make a broader impact? Join the Department of Labor and Industry as a Medical Records Examiner, where your clinical knowledge and critical thinking skills will help support fair and accurate workers’ compensation processes. You will review medical fee review applications by analyzing medical documentation and provider billing, applying workers’ compensation statutes and guidelines, and communicating decisions to all parties involved. You will also provide guidance and technical assistance to medical providers, insurers, employers, and other stakeholders, while supporting the utilization review process by evaluating requests for compliance with regulatory requirements. Bring your clinical experience to a new kind of nursing role—where your attention to detail, strong written and verbal communication skills, and sound judgment can contribute to decisions that matter. This position supports the review and evaluation of medical information to ensure compliance with the Pennsylvania Workers' Compensation Act and Medical Cost Containment requirements. As a Medical Records Examiner, you will perform the following duties: Use the Workers’ Compensation Automation and Integration System (WCAIS) daily to complete tasks and support operational needs. Review medical fee requests to assess contested charges and payment timeliness. Examine medical records, bills, and related documents to verify accuracy and compliance. Prepare correspondence to explain determinations to providers, insurers, and employers. Maintain information on fee schedules and reimbursement guidelines for medical providers. Coordinate utilization review processes and provide assistance to involved parties.

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.
• Active authorization to practice as a Registered Nurse in Pennsylvania.
• 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.
• Meet the PA residency requirement.
• Able to perform essential job functions.

Responsibilities

• Use the Workers’ Compensation Automation and Integration System (WCAIS) daily to complete tasks and support operational needs.
• Review medical fee requests to assess contested charges and payment timeliness.
• Examine medical records, bills, and related documents to verify accuracy and compliance.
• Prepare correspondence to explain determinations to providers, insurers, and employers.
• Maintain information on fee schedules and reimbursement guidelines for medical providers.
• Coordinate utilization review processes and provide assistance to involved parties.

What This Job Offers

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