Medical Records Examiner
Commonwealth of Pennsylvania•Dauphin County, PA
•Hybrid
About 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.
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.
- Possession of an active motor vehicle license.
- Meet the PA residency requirement.
Nice To Haves
- 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.
Responsibilities
- Examine medical records, claims, and related documents to identify issues with compliance or quality of care
- Evaluate provider invoicing patterns and service histories to detect irregularities
- Organize review steps, track progress, and keep supervisors informed of case developments
- Write clear summaries of findings, methods, and recommendations for administrative action
- Participate in discussions with supervisors and legal staff and provide testimony when required
- Respond to tips, complaints, and referrals from various sources and document actions taken
Benefits
- Free parking
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
