Medical Records Examiner

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.

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:

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

Interested in learning more? Additional details regarding this position can be found in the position description.

• Full-time employment, 37.5 hours per week
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Telework:
  You may have the opportunity to work from home (telework) part-time, with the expectation that you will be on-site 2 days per 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.
  
  The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• Salary:
  
  In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

• 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.

• This position requires 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.

• You must meet the PA residency requirement . For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines.
• You must be able to perform essential job functions.

• Pennsylvania law (51 Pa. C.S. 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to (Use the "Apply for this Job" box below). and click on Veterans.

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