Medical Records Examiner

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

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.
• 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.

QUALIFICATIONS

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.

• 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.

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.

• 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 www.pa.gov/agencies/employment/how-to-apply.html 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.

• Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
• Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
• Your score is valid for this specific posting only.
• You must provide complete and accurate information or:
  • your score may be lower than deserved.
  • you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.