Commonwealth of PA Looking for Medical Records Examiner at Dauphin County, PA Full Time

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:

• Full-time employment.
• Hours of work: Monday through Friday, 8:00 AM – 4:00 PM; 30 minute lunch.
• Multiple positions may be filled from this posting.
• Teleworking: You may have the opportunity to work from home (telework), part-time based on operational needs. In order to telework, you must have a securely configured high-speed internet connection. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
• You will receive further communication regarding this position via email. Please check your email, including spam 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.
• SPECIAL REQUIREMENT: All positions require an active license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; or possession of a non-renewable temporary practice permit issued by the Pennsylvania State Board of Nursing.
• SPECIAL REQUIREMENT: All employees having non-renewable temporary practice permits issued by the Pennsylvania State Board of Nursing must obtain licensure as a Registered Nurse, Commonwealth of Pennsylvania 4 within the one (1) year period as defined by the Pennsylvania State Board of Nursing.
• Must meet PA residency requirement – For more information on ways to meet PA residency requirements, follow the link and click on Residency.
• Do not submit resumes, cover letters, and similar documents. These documents will not be reviewed and the information contained therein will not be considered for the purposes of determining your eligibility for the position or to determine your score. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• Must be able to perform essential job functions.

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.

• 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:
  • you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.

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.

Work/Life Balance

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.

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.