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How much do medicare appeal reviewer jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for medicare appeal reviewer in the United States is $25.71, according to ZipRecruiter salary data. Most workers in this role earn between $19.71 and $30.53 per hour, depending on experience, location, and employer.

What is a Medicare appeal reviewer?

A Medicare Appeal Reviewer is responsible for evaluating and processing appeals related to Medicare claims. They review medical records, documentation, and relevant regulations to determine whether a claim denial should be overturned or upheld. This role requires knowledge of Medicare policies, medical terminology, and healthcare regulations. Appeal reviewers ensure that claims are processed fairly and in compliance with federal guidelines. Their work helps beneficiaries receive accurate decisions regarding their healthcare coverage.

What does a Medicare appeal reviewer do?

A typical day for a Medicare Appeal Reviewer involves reviewing and analyzing appeal cases related to denied or disputed Medicare claims, gathering and assessing medical documentation, and making determinations based on regulatory guidelines. You will frequently collaborate with other reviewers, clinical professionals, and claims specialists to resolve complex cases and ensure compliance with federal standards. Clear and comprehensive documentation of findings, as well as regular communication with providers and occasionally patients, are essential parts of the daily workflow. This role offers a balance of independent analysis and teamwork, providing opportunities to develop expertise in healthcare policy and pave the way for advancement into senior review or compliance positions.

What skills and qualifications are needed to be a Medicare appeal reviewer?

To thrive as a Medicare Appeal Reviewer, you need a solid understanding of Medicare regulations, healthcare claims processing, and medical terminology, usually supported by a background in nursing, healthcare administration, or a related field. Familiarity with claims adjudication systems, electronic health records (EHRs), and compliance software is typically required, along with relevant certifications such as Registered Nurse (RN) or Certified Professional Coder (CPC) being advantageous. Strong analytical skills, attention to detail, and effective written and verbal communication are crucial for evaluating documentation and interacting with providers or patients. These abilities ensure accurate, fair, and timely resolution of appeals, which is vital for both regulatory compliance and patient satisfaction.

Who reviews Medicare Appeal Reviewers?

Medicare Appeal Reviewers are typically reviewed by supervisors or managers within the Medicare administrative organization or healthcare agency overseeing appeals. Their performance may also be evaluated through quality assurance processes and adherence to federal guidelines to ensure accurate and consistent decision-making.
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Medicare Appeal Reviewer jobs near you
Infographic showing various Medicare Appeal Reviewer job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 78% Full Time, 14% Part Time, and 4% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $53,482 per year, or $25.7 per hour.

Medicare Clinical Appeals Reviewer III

St. George Tanaq Corporation

Santa Fe, NM • On-site

Other

Posted 21 days ago

Job description

Medicare Clinical Appeals Reviewer III

Fully Remote-United States

Job Type

Full-time

Description

Overview

Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders.

About the Role

We are seeking a Medicare Clinical Appeals Reviewer III (Dispute Resolution Reviewer III) to support our federal client. The Medicare Clinical Appeals Reviewer III is a licensed clinician who independently evaluates complex Medicare appeals and dispute cases, reviews clinical documentation, interprets federal regulations, and issues appeal determinations supported by medical evidence and policy.

They will also provide independent second-level determinations and dispute resolutions based on documentation, facts, laws, regulations, and applicable guidelines. This role works under general supervision with moderate latitude for initiative and independent judgment.

This is a remote position. Candidates must be based in the United States and able to work Eastern, Central, or Mountain Time Zone business hours with availability to work on a rotating schedule on weekends and holidays.

Required: Active, unrestricted license in good standing as an RN, PT, RT, OT, or other qualifying licensed healthcare professional. Licenses with restrictions or encumbrances are not eligible.

Responsibilities

  • Review the medical records/case file, write a reconsideration/dispute resolution decision that is clear, concise, and impartial, supports the determination made, and documents the review.

  • Make fair, impartial, and independent decisions based on current medical evidence, statutes, regulations, rulings, policies, and procedures.

  • Respond to and ensure that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.

  • Conduct research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to make an accurate, well-supported decision.

  • Stay abreast of changes in regulations, medical and healthcare practices, policies, and procedures.

  • Participate in case-specific verbal discussions.

  • Conduct reviews of appeals/disputes involving multiple beneficiaries/services in a single case.

  • Plan responses to statistical analysis challenges with assistance from statisticians.

  • Attend meetings and participate in workgroups at management's direction.

  • Serve as a subject matter expert.

  • Mentors and/or trains staff.

  • Conduct quality reviews and audits, as needed.

  • Participate in special projects and perform other duties as assigned.

Requirements

Required Experience and Skills

  • Must have 2-3 years of experience in medical dispute resolution, Medicare appeals, medical review, clinical review, or a related healthcare setting.

  • Must have Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience. Licensed candidates with closely related clinical or medical experience may be considered.

  • Demonstrated experience writing or making appeal or payment determinations

  • Experience using Microsoft 365, including Excel and Word.

  • Must be able to pass Federal and state criminal background checks, as required by client.

  • Must be able to pass education, certification and license verification, as well as other professional background checks, as required by client.

  • Must be able to pass drug screen, as required by client.

  • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Preferred Qualifications

  • Medicare appeals, medical review, healthcare compliance review, or independent dispute resolution.

  • Experience making determinations on appeals, payments, billing, or dispute resolution.

  • Experience working with or supporting a federal public health agency environment.

  • Patient-Provider Dispute Resolution or Independent Dispute Resolution experience.

  • Coding certification.

Education and Training

  • Must be an actively licensed healthcare professional with Nursing, Physical Therapy, Respiratory Therapy, Occupational Therapy, or closely related clinical experience.

Physical Requirements

  • Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.

Who We Are

Tanaq Support Services (TSS) is a public health contractor and certified 8(a) business owned by St. George Tanaq Corporation, an Alaska Native Corporation (ANC). We listen to our stakeholders and leverage our science, technology, communication, and program expertise to develop effective solutions.

Our commitment to non-discrimination

Tanaq Support Services is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, or any other status protected by applicable federal, state, or local law. Tanaq complies with the Drug-Free Workplace Act of 1988 and participates in E-Verify.

If you are an individual with a disability and need assistance completing any part of the application process, please email accommodation@tanaq.com to request a reasonable accommodation. This email is for accommodation requests only and cannot be used to inquire about the status of applications.

Notice on candidate AI usage

Tanaq is committed to ensuring a fair and competitive interview process for all candidates based on their experience, skills, and education. To protect the integrity of the interview process, candidates may not use artificial intelligence (AI) tools to generate or assist with responses during phone, in-person, or virtual interviews. Candidates who require a reasonable accommodation that may involve AI must contact us before their interview at accommodation@tanaq.com.

To view this and all our job postings, visit us at:

https://recruiting.paylocity.com/recruiting/jobs/All/a4712c9f-f074-40e8-9a14-bee06660bd81/Tanaq-Support-Services-LLC

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