Medical Records Examiner

Commonwealth of Pennsylvania • *Home Headquartered, PA

17h • Remote

About The Position

As a Medical Records Examiner with the Division of Fee-for Service Operations, you will contribute to the well-being of individuals who rely on long term living services. This role plays an essential part in ensuring nursing facilities follow important rules and provide the care residents need. Your work helps strengthen the integrity of statewide programs by promoting compliance and quality. This is your opportunity to make a meaningful impact through dedicated public service.

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.
• Must obtain licensure as a Registered Nurse within the one (1) year period defined by the Pennsylvania State Board of Nursing if possessing an active temporary practice permit.
• Active motor vehicle license.
• Must meet the PA residency requirement.
• Must be able to perform essential job functions.

Responsibilities

• Assess medical, physical, rehabilitative, and restorative services to determine their appropriateness
• Compare facility practices with federal, state, and departmental policies to ensure adherence
• Examine Minimum Data Set submissions and verify documentation accuracy in clinical records
• Monitor nursing facility admissions and evaluate discharge planning through clinical record review
• Review billing and payment activity to identify recoveries and validate proper documentation
• Conduct entrance and exit conferences and manage required activities before, during, and after facility reviews

What This Job Offers

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