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Reference #: 4556292 THE POSITION Are you a detail-oriented, organized, and motivated healthcare professional who would enjoy analyzing complex medical records and documentation? The Department of Labor and Industry is eager to welcome a Medical Records Examiner to review medical treatment on worker's compensation claims in order to determine the appropriateness of the treatment and its conformity with the Pennsylvania Worker's Compensation Act. Showcase your experience and knowledge in the field while providing vital services to your fellow Pennsylvanians!

DESCRIPTION OF WORK

As a Medical Records Examiner, you will perform a wide range of duties, including reviewing files and medical bills referred by claim's personnel and district office personnel for the purpose of utilization review, bill payment, bill audits, current procedural terminology (CPT) coding, trauma, liability, and medical status updates. You will be reviewing catastrophic claims as well as medical records and providing assistance with nursing care plan (NCP) wording as requested by district office personnel.

Excellent communication skills are essential, as you will be interacting with field-based medical management nurses while monitoring medical management reports. You will also network with pharmacy benefit managers (PBMs), the control unit, the legal division, claims service coordinators and handlers, the fraud unit, and supervisors regarding assigned files.

Interested in learning more?  Additional details regarding this position can be found in theposition description.

Work Schedule and Additional Information: Full-time employment 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.  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 Scranton. 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: All positions require 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.

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.

You must be able to perform essential job functions.

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.

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 ra-cs-vetpreference@pa.gov.

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.

EXAMINATION INFORMATION

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: your score may be lower than deserved. you may be disqualified. You may only apply/test once for this posting. Your results will be provided via email.

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.