Medical Records Examiner
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Medical Records Examiner
Salary
$67,736.00 - $102,905.00 Annually
Location
*Home Headquartered, PA
Job Type
Civil Service Permanent Full-Time
Job Number
CS-2026-42897-39570
Department
Department of Human Services
Division
HS Div Qlty Assur
Opening Date
02/18/2026
Closing Date
3/4/2026 11:59 PM Eastern
Job Code
39570
Position Number
50703061
Union
FOP Lodge 92
Bargaining Unit
G4
Pay Group
ST08
Bureau / Division Code
00211953
Bureau / Division
Division of Quality Assurance
City
Home Headquartered
Contact Name
Winona Fedin
Contact Email
wfedin@pa.gov
Description
Benefits
Questions
THE POSITION
Are you a detail-oriented registered nurse committed to ensuring high-quality care for Pennsylvania's most vulnerable residents? The Department of Human Services is seeking a dynamic and enthusiastic Medical Records Examiner with a strong work ethic to join our Office of Long-Term Living (OLTL). In this important role, you will conduct clinical reviews and evaluate service denials as part of the Clinical Review Team, helping to safeguard care quality and uphold program integrity. If you are eager to take on new challenges, expand your expertise, and make a meaningful impact through your clinical knowledge and analytical skills, we encourage you to apply and advance your professional career!
DESCRIPTION OF WORK
In this position, you will support clinical reviews of denials related to physical health services, pharmacy benefits, and long-term services and supports. Your responsibilities include evaluating whether appropriate denial notices were issued, required timelines were met, determinations were supported by the available documentation, and appeal rights were clearly and accurately communicated. You will assist the OLTL Medical Director in reviewing Medical Director determinations involving discrepancies between Functional Eligibility Determinations and physician certifications. In this work, you will develop a strong understanding of nursing facility clinical eligibility and ineligibility criteria, thoroughly review participant health records, and compile all necessary documentation to ensure comprehensive and accurate evaluations. In addition, you will support the review and assessment of the Licensed Proprietary Products (LPP) annual report, helping to ensure that LPPs remain clinically sound, operationally appropriate, current in practice, and aligned with nationally recognized standards of care.
Interested in learning more? Additional details regarding this position can be found in the position description (https://careers.employment.pa.gov/pd/PD_NEOGOV.asp?p=50703061) .
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.
This position is home headquartered. In order to be home headquartered, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania.
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:
This position requires 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 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 (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) . For more information on ways to meet PA residency requirements, follow the link (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) and click on Residency.
You must be able to perform essential job functions.
How to Apply:
Resumes, cover letters, and similar documents willnotbe 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.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.
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.
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/testoncefor this posting.
Your results will be provided via email.
Learn more about our Total Rewards by watching this shortvideo (https://www.youtube.com/embed/HtcSRnndflc?rel=0) !
See the total value of your benefits package by exploring ourbenefits 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 visitwww.employment.pa.gov and click on the benefits box.
*Eligibility rules apply.
01
You must complete the supplemental question(s) below. Failure to provide complete and accurate information may delay the processing of your application or result in a lower-than-deserved score or disqualification. Youmustcomplete the applicationandanswer the supplemental question(s). Resumes, cover letters, and similar documents willnotbe reviewed for the purposes of determining your eligibility for the position or to determine your score.
All information you provide on your application and supplemental question(s) is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty.
Read the question(s) carefully. Determine and select the option that most closely represents your highest level of experience/training/certification. The option you choose must be clearly supported if requested.
If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions.
If you have general questions regarding the application and hiring process, please refer to ourFAQ page (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) .
Yes
02
Do you possess active authorization to practice as a Registered Nurse in Pennsylvania; or do you possess an active temporary permit to practice as a Registered Nurse in Pennsylvania?
Yes
No
03
If yes, please list the state that issued your license, your license number, and the expiration date. If you answered no to the question above, please @type N/A in the box below.
04
How many years of full-time professional experience do you possess in the field of medical assistance, health care services, or human services?
3 years or more
2 but less than 3 years
1 but less than 2 years
Less than 1 year
None
05
If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, @type N/A in the text box below.
06
How much graduate coursework have you completed in addiction studies; health and risk communication; health care administration/management; health care informatics/information management; health economics; health education; health insurance studies; health leadership; health policy; health sciences; health services; occupational health and safety; occupational therapy; quality, safety and risk management in health care; physical therapy; psychology; public health; social work; speech therapy; or vocational rehabilitation?
If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted.
If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visitingwww.naces.organd clicking the Evaluation Services Link.
You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted.
60 credits or more
45 but less than 60 credits
30 but less than 45 credits
15 but less than 30 credits
Less than 15 credits
None
Required Question
Employer
Commonwealth of Pennsylvania
Address
613 North Street
Harrisburg, Pennsylvania, 17120
Website
http://www.employment.pa.gov
