Medical Records Examiner

THE POSITION

As a Medical Records Examiner with the Department of Human Services (DHS), you will play a key part in maintaining the standards of medical services across the state. This position gives you the chance to use your clinical background while supporting the fair use of Medical Assistance resources. You will help identify discrepancies, promote compliance, and conduct reviews of provider practices. This role provides a rewarding way to make a difference in public service.

DESCRIPTION OF WORK

This position reviews and evaluates medical services provided under the Medical Assistance Program to help ensure that care meets required standards. The work supports the detection of potential fraud, waste, and abuse while maintaining program integrity. As a Medical Records Examiner, you will perform the following duties:

• Case Review: Examine medical records, claims, and related documents to identify issues with compliance or quality of care
• Data Analysis: Evaluate provider invoicing patterns and service histories to detect irregularities
• Case Coordination: Organize review steps, track progress, and keep supervisors informed of case developments
• Report Preparation: Write clear summaries of findings, methods, and recommendations for administrative action
• Meetings and Testimony: Participate in discussions with supervisors and legal staff and provide testimony when required
• Provider Communication: Respond to tips, complaints, and referrals from various sources and document actions taken

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
• Telework: You may have the opportunity to work from home (telework) part-time, up to three 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.

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

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:

• You must possess 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.

This position is subject to the provisions of a collective bargaining agreement or memorandum of understanding.

You must be eligible for selection in accordance with merit system employment regulations. 

Recruitment Methods: 

• Applicants must meet one of the following methods to be considered for this vacancy: 
  • Reassignment (Only current civil service employees in the same agency who hold the same or similar job title, with the same maximum salary, within the same occupational group or where there is a logical career movement, will qualify for reassignment.)
  • Transfer (Only current civil service employees who hold the same job title will qualify for transfer to another agency.)
  • Voluntary Demotion
  • Reinstatement (Former civil service employees may only be reinstated to the job title from which they resigned. Current civil service employees are not eligible through reinstatement.)

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.

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.

Benefits

Learn more about our Total Rewards by watching this short video!

See the total value of your benefits package by exploring our benefits calculator.

Health & Wellness

We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*

Compensation & Financial Planning
We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options. 

Work/Life Balance
We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.* 

Values and Culture
We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.

Employee Perks
Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.

For more information on all of these Total Rewards benefits, please visit www.employment.pa.gov and click on the benefits box.

*Eligibility rules apply.

Supplemental Questions

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Agency Information

EmployerCommonwealth of PennsylvaniaAddress 613 North Street

Harrisburg, Pennsylvania, 17120 Website http://www.employment.pa.gov