The Bureau of Workers’ Compensation is seeking an individual to provide professional support to ensure operations are maintained within the guidelines of the Medical Cost Containment (MCC) regulations and conducted professionally, efficiently, and accurately.
If you are a Registered Nurse, and are looking for a career change, the Department of Labor and Industry wants you to apply today!
This position reviews and processes requests for medical fee review of contested amount and/or timeliness of medical payments for services rendered to injured workers. Examines and evaluates medical bills, medical reports, legal documents, compensation forms, decisions, and other documentation as part of the statutorily required investigation to determine whether fees paid to health care providers are of the correct amount and/or paid within the statutorily required time frame.
The Medical Records Examiner makes determinations of amount of medical fees owed based on medical documentation, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS), Diagnosis-related group (DRG) and Part A Outpatient Coding. Also they issue administrative decisions and prepares appropriate forms and correspondence to communicate findings to all parties including health care providers, insurers, self-insureds, and employers.
This position evaluates applications and or reauthorizations of Utilization Review Organizations (URO) requesting certification to operate as a URO under the Workers’ Compensation Act. Evaluates the qualifications of the URO including the medical experiences and training of personnel, past performance, and its ability to comply with criteria established by the BWC for URO certification.
Additional details regarding the duties of this position may be found in the position description.
Work hours and 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.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans’ Preference tab or contact us at [email protected].
Telecommunications Relay Service (TRS): 711 (hearing and speech disabilities or other individuals).
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.
Learn more about our Total Rewards by watching this short video!
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.
We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, six 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.
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.