Medical Records Examiner

About the role

Are you interested in using your medical coding expertise to support a major statewide health program? The Medical Records Examiner position with the Department of Human Services offers a meaningful way to support the Medicaid Program. This role allows you to apply your knowledge of medical coding to help ensure accurate and efficient claims processing. You contribute to improving systems and procedures that strengthen health services for communities across Pennsylvania. Your work helps maintain reliable program operations every day.

Responsibilities

• Evaluate procedure codes and related documentation to support fee schedule decisions
• Assess claims, encounters, and submissions from providers and agencies to form professional judgments
• Participate in project teams and workgroups and assist in guiding review processes
• Provide consultative support to staff and stakeholders on coding, policy, and system procedures
• Examine current procedures and contribute recommendations for improvements
• Collaborate with policy staff in the development of code set updates, related communications, and provider bulletins

Qualifications

Required Experience, Training & Eligibility

• 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

• Active authorization to practice as a Registered Nurse in Pennsylvania
• If you possess an active temporary practice permit, you must obtain licensure as a Registered Nurse within one year as defined by the Pennsylvania State Board of Nursing
• Must meet the PA residency requirement
• Must be able to perform essential job functions

Schedule

Full-time employment, 37.5 hours per week. Work hours are 7:30 AM to 4:00 PM, Monday – Friday, with a 60-minute lunch.

Telework: Part-time up to 3 days per week from an approved location inside Pennsylvania, subject to change at any time.

Pay

Salary information provided during the interview process.