As a Medical Records Examiner with the Division of Fee-for-Service Operations, you will help support the well-being of individuals who rely on long-term living services. This role plays an important part in ensuring nursing facilities follow federal and state rules and provide appropriate care. Your work will strengthen statewide program integrity through compliance review and quality oversight.
This position focuses on reviewing clinical and financial records to confirm that nursing facilities follow federal and state requirements. You will perform duties such as:
- Care Review: Assess medical, physical, rehabilitative, and restorative services to determine appropriateness
- Regulation Compliance: Compare facility practices with federal, state, and departmental policies to ensure adherence
- Program Evaluation: Examine Minimum Data Set submissions and verify documentation accuracy in clinical records
- Admission Assessment: Monitor nursing facility admissions and evaluate discharge planning through clinical record review
- Financial Monitoring: Review billing and payment activity to identify recoveries and validate proper documentation
- Facility Coordination: Conduct entrance and exit conferences and manage required activities before, during, and after facility reviews
This is a home-headquartered position that requires working from an approved location inside Pennsylvania with securely configured high-speed internet access.
Qualifications
Minimum Experience and Training Requirements
- Three years of professional experience in the field of medical assistance, health care services, or human services
- An equivalent combination of experience and training may be considered
Special Requirements
- Active authorization to practice as a Registered Nurse in Pennsylvania
- If holding an active temporary practice permit, licensure as a Registered Nurse must be obtained within one year as defined by the Pennsylvania State Board of Nursing
- Active motor vehicle license
Other Requirements
- Must meet the Pennsylvania residency requirement
- Must be able to perform essential job functions
Application Notes
- Resumes, cover letters, and similar documents will not be reviewed
- Application materials must include all information needed to determine eligibility
- If claiming education, unofficial college transcripts must be attached
- Application must be submitted by the posting closing date
- Only one application/test submission is allowed for this posting
Location
Pennsylvania, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago