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Medicare Claim Reviewer Jobs (NOW HIRING)

OpTech LLC

Medicare Claims Analyst

Detroit, MI · On-site

Skills/Experience/Education: * Medical claims analysis (Medicare Advantage preferred ... Conducting detailed claim reviews to validate reimbursement accuracy * Identifying and resolving ...

OpTech LLC

Medicare Claims Analyst

Detroit, MI · On-site

Skills/Experience/Education: * Medical claims analysis (Medicare Advantage preferred ... Conducting detailed claim reviews to validate reimbursement accuracy * Identifying and resolving ...

Bacon County Hospital

Medicare Biller

Alma, GA · On-site

These efforts minimize claim denials, optimize reimbursement for the hospital, and help reduce ... Reviews and follows up in a timely manner all balances on accounts. Works with patients and ...

Commence

VA · On-site

$82K - $95K/yr

The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims ... Support claim(s) re-review when additional documentation is submitted * Maintain a 95%+ individual ...

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Medicare Claim Reviewer information

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How much do medicare claim reviewer jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for medicare claim reviewer in the United States is $19.85, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $21.63 per hour, depending on experience, location, and employer.

What is the difference between Medicare Claim Reviewer vs Medicare Billing Specialist?

AspectMedicare Claim ReviewerMedicare Billing Specialist
Required CredentialsTypically requires healthcare-related certifications, such as CPC or CCSOften requires similar certifications, with additional billing or coding credentials
Work EnvironmentHealthcare facilities, insurance companies, or government agenciesMedical offices, billing companies, or insurance providers
Employer & Industry UsageUsed in healthcare and insurance sectors for claims processingCommon in medical billing and coding departments
Search & Comparison IntentOften compared for claims review and audit rolesCompared for billing, coding, and reimbursement tasks

The Medicare Claim Reviewer and Medicare Billing Specialist roles share overlapping credentials and work environments, but differ mainly in their focus. The reviewer primarily audits and verifies claims for accuracy, while the billing specialist handles the submission and management of claims for reimbursement. Both roles are essential in healthcare billing processes and often work within similar settings.

How to become a Medicare Claim Reviewer?

To become a Medicare Claim Reviewer, candidates typically need a background in healthcare, insurance, or claims processing, along with knowledge of Medicare policies. Relevant certifications, such as Certified Professional Coder (CPC) or claims processing training, can enhance job prospects. Strong attention to detail and familiarity with healthcare management systems are also important for success in this role.

What does a Medicare claim reviewer do?

A Medicare claim reviewer evaluates insurance claims related to Medicare to determine their accuracy, completeness, and compliance with regulations. They review medical documentation, verify billing codes, and ensure proper payment processing, often using specialized software and adhering to federal guidelines.

What states have the most Medicare Claim Reviewer jobs?

States with the most job openings for Medicare Claim Reviewer jobs include:

What are popular job titles related to Medicare Claim Reviewer jobs?

For Medicare Claim Reviewer jobs, the most frequently searched job titles are:

Medicare Billing Specialist

Charleston, IL • On-site

Healthcare Nursing Center
See more jobs at Healthcare Nursing Centerexternal

$17.25 - $22/hr

Full-time

Re-posted 21 days ago

Job description

Medicare Billing Specialist

Location: Charleston, Illinois (on-site)
Reports To: Billing Director

About the Opportunity

The Medicare Billing Specialist is responsible for ensuring accurate and timely billing of all Medicare claims within a skilled nursing environment. This role requires deep knowledge of Medicare regulations and a high level of precision.

Key Responsibilities

Medicare Billing

  • Prepare and submit Medicare Part A and Part B claims accurately and on time

  • Ensure compliance with PDPM and all Medicare billing guidelines

  • Verify documentation supports billing prior to submission

Accuracy & Compliance

  • Review claims for completeness and accuracy

  • Identify and resolve billing discrepancies or missing information

  • Stay up to date on Medicare regulations and changes

Denials & Follow-Up

  • Manage Medicare claim rejections and denials

  • Correct and resubmit claims promptly

  • Work closely with AR team to ensure payment is received

Systems

  • Utilize PointClickCare (PCC) for billing and claim management

  • Maintain accurate records and documentation within systems

Qualifications

  • MUST have SNF Medicare billing experience

  • 3+ years of Medicare billing experience in long-term care

  • Strong understanding of PDPM and Medicare regulations

  • Experience with PointClickCare (PCC) required

  • Detail-oriented with strong accuracy and compliance focus