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Medical Claim Reviewer Jobs in Reston, VA (NOW HIRING)

MedVanta

Healthcare Account Analyst

Bethesda, MD · On-site

Refers the claim to the cost containment and RxOps departments for review of high dollar charges if ... with medical terminology Preferred: • 3 years of experience in a Stop Loss Claims Analyst role ...

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All JobsMedical Claim Reviewer JobsMedical Claim Reviewer Jobs in Reston, VA

Medical Claim Reviewer information

See Reston, VA salary details

$5

$17

$19

How much do medical claim reviewer jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for medical claim reviewer in Reston, VA is $17.51, according to ZipRecruiter salary data. Most workers in this role earn between $16.01 and $18.99 per hour, depending on experience, location, and employer.

How to be a medical claim reviewer?

To become a medical claim reviewer, typically one needs a background in healthcare, insurance, or related fields, along with knowledge of medical coding and billing. Many employers prefer candidates with certifications such as the Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS). Strong attention to detail, analytical skills, and familiarity with claims processing software are also important for success in this role.

What is the difference between Medical Claim Reviewer vs Medical Claims Processor?

AspectMedical Claim ReviewerMedical Claims Processor
Required CredentialsHigh school diploma or equivalent; certifications like CPC or CCS beneficialHigh school diploma or equivalent; certifications less common
Work EnvironmentInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare facilities, billing departments
Job FocusReviewing and verifying claims for accuracy and complianceProcessing and entering claims data into systems
Common Search IntentUnderstanding roles, responsibilities, and qualificationsLearning about claims processing tasks and requirements

The main difference is that Medical Claim Reviewers focus on evaluating and verifying claims for accuracy and compliance, while Medical Claims Processors handle the data entry and initial processing of claims. Both roles are essential in the claims management process and often work closely within insurance and healthcare organizations.

What are the key skills and qualifications needed to thrive as a medical claim reviewer?

To thrive as a Medical Claim Reviewer, you need a solid understanding of medical terminology, insurance policies, and claims processing, often supported by a degree in health administration or related field. Familiarity with claims management software, coding systems like ICD-10 and CPT, and regulatory compliance is typically required. Attention to detail, analytical thinking, and strong communication skills set top performers apart in this position. These skills are crucial to accurately evaluating claims, ensuring regulatory compliance, and minimizing errors or fraud in healthcare billing.

What are some common challenges faced by medical claim reviewers, and how can they be managed?

Medical Claim Reviewers often face challenges such as interpreting complex medical records, keeping up with frequent changes to insurance policies, and managing high volumes of claims within tight deadlines. Effective time management, ongoing training, and strong communication skills are key to overcoming these obstacles. Collaborating closely with healthcare providers and insurance representatives also helps ensure accurate claim assessments and fosters a smoother workflow.

What does a medical claim reviewer do?

A Medical Claim Reviewer is responsible for evaluating medical insurance claims to determine their accuracy, completeness, and compliance with policy guidelines. They review the documentation submitted by healthcare providers and patients, verify medical codes, and ensure that the treatments or services billed are medically necessary and covered by the insurance plan. Their work helps prevent fraudulent claims and ensures that insurance payments are processed fairly and correctly.

What are popular job titles related to Medical Claim Reviewer jobs in Reston, VA?

For Medical Claim Reviewer jobs in Reston, VA, the most frequently searched job titles are:

What job categories do people searching Medical Claim Reviewer jobs in Reston, VA look for?

The top searched job categories for Medical Claim Reviewer jobs in Reston, VA are:

What cities near Reston, VA are hiring for Medical Claim Reviewer jobs?

Cities near Reston, VA with the most Medical Claim Reviewer job openings:

Medical Claim Reviewer jobs near you

Medical Collection & Billing Specialist

Addison Group

Bethesda, MD • On-site

$23/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 11 days ago

Job description

Job Title: Medical Collection & Billing Specialist
Location: Bethesda, MD (Onsite)
Industry: Healthcare / Revenue Cycle Management
Pay: $23 per hour
Benefits: This position is eligible for medical, dental, vision, life insurance and 401k.
About Our Client
Addison Group is partnering with a growing healthcare organization seeking an experienced Medical Collection & Billing Specialist to join its Central Billing Office team. This position is ideal for someone with strong medical billing and insurance accounts receivable experience who enjoys working directly with insurance carriers to resolve claims and maximize reimbursement.
Job Description
The Medical Collection & Billing Specialist is responsible for managing insurance accounts receivable, resolving denied claims, submitting appeals, and working accounts through the full reimbursement cycle. This role works primarily with insurance companies rather than patients , making it ideal for candidates with a strong payer follow-up and medical billing background.
Key Responsibilities
  • Investigate and resolve denied, underpaid, and unpaid insurance claims.
  • Manage assigned accounts receivable across all aging buckets.
  • Submit corrected claims and appeals to insurance carriers.
  • Perform insurance follow-up to ensure timely reimbursement.
  • Coordinate and submit medical records and supporting documentation for appeals.
  • Review claim status and communicate with commercial and government payers regarding outstanding accounts.
  • Assist with medical billing functions, including claim submission, payment posting, and account reconciliation.
  • Maintain accurate documentation of all account activity and follow-up efforts.
  • Prepare status updates and maintain organized records of assigned accounts.
  • Collaborate with internal departments to resolve billing discrepancies and improve reimbursement outcomes.

Requirements:
  • 2+ years of recent medical billing and/or accounts receivable experience required.
  • Strong experience working directly with insurance companies (minimal patient interaction).
  • Experience with insurance follow-up, denials, appeals, and claims resolution required.
  • Knowledge of medical terminology, insurance benefits, and healthcare billing processes.
  • Experience working with both commercial and government payers .
  • Orthopedic or musculoskeletal billing experience is a plus but not required.
  • Experience with ModMed (Modernizing Medicine) or similar practice management systems is preferred.
  • Strong attention to detail, organizational skills, and ability to manage a high-volume workload.
  • Excellent communication and problem-solving skills.

Additional Details
  • Schedule: Monday-Friday, 8:00 AM - 4:30 PM
  • Work Model: Fully onsite
  • Environment: Central Billing Office
  • Productivity: Manage approximately 40-50 insurance claims per day

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.
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