Medical Records Examiner

Description of Work

This position supports the review and evaluation of medical information to ensure compliance with the Pennsylvania Workers' Compensation Act and Medical Cost Containment requirements.

Responsibilities

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

Work Schedule

• 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.

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.

Special Requirements: 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.