Reference #: 4656247
THE POSITION
Are you ready to take your registered nursing background in a new direction? Do you want to conduct investigations that help protect the health of your fellow Pennsylvanians? The Department of Human Services (DHS), Bureau of Program Integrity is seeking a Medical Records Reviewer. If you want a career that appeals to your strong sense of ethics, then we want to talk to you! Apply today!DESCRIPTION OF WORK
A Medical Records Examiner conducts site visits and records findings to detect fraud and abuse rendered by providers under the Pennsylvania Medical Assistance (MA) Program. You will review documents, claims, and services to determine medical necessity and compliance with MA, state, and federal requirements. You will also participate in evidentiary meetings, testify at administrative hearings or trials, and respond to requests for information from external agencies. This position requires the ability to work independently, as well as maintain a high degree of confidentiality with sensitive information.Interested in learning more? Additional details regarding this position can be found in the position description.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.
Free parking!
Telework: You may have the opportunity to work from home (telework) part-time, working 2 days per week in the office. 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 Harrisburg.
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 & ELIGIBILITYQUALIFICATIONS
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.
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.Telecommuni ations 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 INFORMATIONCompleting 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.
