Medical Record Content Reviewer Advanced Level Quality Patient Centered Services LLC (QPCS) is seeking an analytical and detail-oriented Medical Record Content Reviewer to support the Pennsylvania Department of Human Services' Bureau of Program Integrity. This position reviews outpatient medical services, paid claims, billing practices, and supporting clinical documentation to help ensure services provided through Pennsylvania's Medical Assistance Program are medically necessary, properly documented, and billed in accordance with applicable requirements.

Position Details Location:

625 Forster Street, Harrisburg, PA 17120

Department:

Pennsylvania Department of Human Services (DHS)

Program:

OMAP -

Program Integrity Position Level:

Advanced Schedule:

8:00 a.m.-4:00 p.m. with a 30-minute unpaid lunch Training and Hybrid Schedule This position requires approximately six to eight weeks of in-office training at the Harrisburg location. After successfully completing training, the position transitions to a hybrid schedule consisting of: Three remote workdays each week Two required in-office workdays each week The hybrid arrangement is subject to operational needs and successful completion of the required training period. Compensation Options Tier 1 - Benefits-Eligible W-2: $21 per hour Tier 2 - Non-Benefits-Eligible W-2: $24 per hour 1099

Independent Contractor:

$26 per hour Important 1099

Notice:

Independent contractors are self-employed and are not eligible for employee benefits, paid time off, unemployment insurance, workers' compensation coverage, or employer-paid payroll taxes. Independent contractors are responsible for their own taxes, insurance, and other applicable obligations. Advanced Level Opportunity The successful Medical Record Content Reviewer can complete assigned responsibilities independently and serve as a knowledgeable resource when challenging questions arise regarding medical documentation, paid claims, billing compliance, and program-integrity reviews. Key Responsibilities Analyze paid claims and computer-generated reports to identify discrepancies, high-cost or high-volume billing patterns, and potential cases for review. Conduct retrospective reviews to evaluate medical necessity, quality of care, documentation adequacy, appropriate billing, and regulatory compliance. Verify that ordered services were provided and that rendered services were properly ordered, documented, and appropriate. Review claims for potential upcoding, duplicate billing, unbundling, and noncompliance with DHS billing guidance. Use ICD-10-CM, HCPCS, coding guidance, and related resources to determine whether paid claims were billed appropriately. Serve as case coordinator for assigned reviews, maintain accurate case-tracking information, and keep supervisors informed of case progress. Prepare case findings, provider correspondence, memoranda, reports, complaint responses, and referrals to other agencies. Participate in provider conferences, evidentiary meetings, hearings, and discussions with clinical, legal, managed-care, and agency representatives. Maintain discretion and protect confidential healthcare and program information. Minimum Qualifications Associate's degree in Health Services Management or two years of healthcare-management experience. Outpatient healthcare experience is preferred. Ability to review and evaluate medical, clinical, billing, and fiscal documentation. Knowledge of Microsoft Office products, including training or proficiency in Excel. Ability to understand and apply policies, procedures, rules, and regulations. Strong analytical, written, verbal, correspondence, and report-preparation skills. Ability to organize assignments, manage deadlines, and maintain effective professional relationships. Ability to exercise discretion, preserve confidentiality, and testify in legal proceedings when required. Availability to attend required meetings, hearings, and training sessions. Help Protect Program Integrity As a Medical Record Content Reviewer with QPCS, your work will help ensure publicly funded healthcare services are properly documented, appropriately billed, and delivered in accordance with established requirements. Apply today to bring your healthcare-review experience, analytical skills, and attention to detail to a meaningful public-service opportunity.

Pay:

$21.00 - $26.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance Application Question(s):

MUST ACKNOWLEDGE

1099

Acknowledgment:

If I am engaged, or elect to be engaged, as a 1099 independent contractor, I understand that I am not an employee of QPCS and am not eligible for employer-sponsored fringe benefits, workers' compensation coverage, or unemployment compensation through QPCS, except as otherwise required by applicable law. I understand that I am responsible for my own taxes, insurance, and business expenses.

Education:

Associate (Preferred)

Experience:

Outpatient healthcare: 1 year (Preferred) Healthcare management: 2 years (Preferred)

Work Location:

In person