Top 5 Claims examiner Jobs in Home, Pa

Medical Records Examiner
Commonwealth of PA —Home, PA
- $69,086 - $104,959 a year
- Full-time
- RN License
- Mid-level
- 3 years
- Paid parental leave
- Health insurance
3d
Digital Forensic Examiner 1
Commonwealth of PA —Indiana, PA
- $69,086 - $104,959 a year
- Full-time
- Computer Science
- Mid-level
- Driver's License
- Paid parental leave
- Health insurance
3d

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Medical Records Examiner

Commonwealth of PA -
Home, PA

Apply Now

Job Details

Full-time
$69,086 - $104,959 a year
3 days ago

Benefits

Paid parental leave
Internal mobility program
Health insurance
Dental insurance
Military leave
Paid time off
Paid military leave
Parental leave
Vision insurance
Flexible schedule
Retirement plan
Paid sick time

Qualifications

RN License
Driver's License

Full Job Description

THE POSITION

As a Medical Records Examiner with the Division of Fee-for Service Operations, you will contribute to the well-being of individuals who rely on long term living services. This role plays an essential part in ensuring nursing facilities follow important rules and provide the care residents need. Your work helps strengthen the integrity of statewide programs by promoting compliance and quality. This is your opportunity to make a meaningful impact through dedicated public service.

DESCRIPTION OF WORK

This position focuses on reviewing clinical and financial records to confirm that nursing facilities follow federal and state requirements. As a Medical Records Examiner, you will perform the following duties:

Care Review: Assess medical, physical, rehabilitative, and restorative services to determine their 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

Interested in learning more? Additional details regarding this position can be found in the position 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.
Home Headquartered: 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.
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.
This position requires an active motor vehicle license.

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 Guidelines.
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.
All application materials and interview responses must reflect the applicant’s own experience, qualifications, and work. Applicants may use generative AI tools for preparation purposes only. Use of AI to misrepresent or falsify information, or to assist during interviews, is not permitted. Review the Guidance for Generative AI Tools & Job Seekers for additional information.

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/test once for this posting.
Your results will be provided via email.

Learn more about our Total Rewards by watching this short video!

See the total value of your benefits package by exploring our benefits 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 visit www.employment.pa.gov and click on the benefits box.

Eligibility rules apply.

Apply Now

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claims examiner jobs in home, pa

Medical Records Examiner

Digital Forensic Examiner 1

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THE POSITION

DESCRIPTION OF WORK

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

EXAMINATION INFORMATION

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