Medical Records Examiner

Medical Records Examiner

Are you eager to use your clinical expertise in a role that strengthens the integrity of healthcare services as a Medical Records Examiner with the Department of Human Services? This position lets you apply your nursing knowledge to ensure that care provided to recipients meets essential standards. You will help protect program quality by reviewing records and identifying concerns. Join this mission-driven agency and support fair, safe, and accurate medical assistance practices.

This position centers on evaluating medical records, analyzing provider practices, and supporting case development to ensure compliance with Medical Assistance regulations. It involves conducting reviews, preparing documentation, and helping guide administrative actions. As a Medical Records Examiner, you will perform the following duties:

• Record Analysis: Review medical records, claims history profiles, and related documents to identify discrepancies
• Case Coordination: Plan and direct case review activities while keeping the supervisor updated on progress
• Provider Evaluation: Conduct on-site visits, interviews, and peer review meetings to assess service quality and detect potential fraud
• Report Preparation: Prepare written reports summarizing reasons for review, findings, violations, and recommendations
• Meeting Participation: Participate in evidentiary meetings and discuss case history, findings, and strategies with agency staff
• Case Testimony: Appear as a witness in hearings or trials to provide information related to case development and evidence handling

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

Work Schedule and Additional Information:

• 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.
• Free parking is included with this position.
• Telework: You may have the opportunity to work from home (telework) part-time, up to 3 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.

Minimum Experience and Training 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.

Special Requirements:

• This position requires active authorization to practice as a Registered Nurse in Pennsylvania.
• 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.
• You must be in possession of an active motor vehicle license.

Other Requirements:

• 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.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.
• All application materials and interview responses must reflect the applicant's own experience, qualifications, and work. Applicants may use generative AI tools for preparation purposes only. Use of AI to misrepresent or falsify information, or to assist during interviews, is not permitted. Review the Guidance for Generative AI Tools & Job Seekers for additional information.

Veterans:

• 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 and click on Veterans.

Telecommunications Relay Service (TRS): 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.