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Medicare Reviewer Jobs (NOW HIRING)

Empower AI

Medical Reviewer III (Medicare/DRG)

Medical Review Specialist III (Medicare DRG) Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation.

Empower AI

Medical Reviewer III (Medicare/DME)

Medical Review Specialist III As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for ...

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.

Empower AI Inc.

As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.

Ovation Healthcare

Specialist, Medicare

Review patient accounts and reconcile payments with Medicare remittance advice, ensuring all payments are posted correctly and outstanding balances are addressed. Communicate with patients regarding ...

EVERENCE SERVICES,

Medicare Part D Specialist

Goshen, IN · On-site

POSITION SUMMARY Review and assist Everence Medicare Supplement members with Medicare Part D. RESPONSIBILITIES AND DUTIES * Develop and maintain a strong understanding of Medicare Part D prescription ...

Verve LLC

Medical Nurse Reviewer

Baltimore, MD · On-site

Review hospice claims, clinical documentation, and provider records to assess compliance with Medicare and Medicaid hospice regulations. * Conduct medical necessity reviews to determine ...

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Medicare Reviewer information

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How much do medicare reviewer jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for medicare reviewer in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.54 per hour, depending on experience, location, and employer.

How do you become a medical reviewer?

To become a Medicare reviewer, candidates typically need a medical degree such as an MD or DO, along with clinical experience. Additional qualifications often include knowledge of Medicare policies, strong analytical skills, and sometimes certification in healthcare compliance or coding; familiarity with medical record review tools is also beneficial.

What jobs pay 2000 a day?

High-paying roles such as Medicare reviewers typically do not earn $2,000 per day; most healthcare or administrative jobs pay less. Positions that can reach this level often involve specialized consulting, executive roles, or highly experienced professionals in finance, law, or technology, often requiring advanced certifications and significant expertise. Such earnings are usually associated with freelance consulting, executive management, or specialized medical consulting rather than standard employment roles.

What are the common challenges faced by Medicare Reviewers in their daily work?

Medicare Reviewers often encounter the challenge of interpreting complex medical documentation and ensuring claims meet evolving Medicare guidelines. The role requires staying current on frequently changing regulations, which demands ongoing learning and adaptability. Balancing efficiency with accuracy is crucial, as reviewers may handle a high volume of cases with varying complexity. Collaborating with medical providers, billing teams, and compliance staff is a regular part of the job, which enhances accuracy but can introduce coordination challenges. Despite these hurdles, many Medicare Reviewers find the work rewarding as it directly impacts patient care quality and healthcare cost management.

How to become a Medicare reviewer?

To become a Medicare reviewer, candidates typically need a background in healthcare, such as nursing, medical coding, or health administration, along with knowledge of Medicare policies. Relevant certifications like Certified Professional Coder (CPC) or healthcare compliance credentials can enhance prospects. Experience with medical records review and familiarity with healthcare software are also beneficial.

What is a Medicare Reviewer job?

A Medicare Reviewer is responsible for evaluating medical claims, patient records, and healthcare services to ensure they meet Medicare guidelines and regulations. They analyze documentation to determine medical necessity, accuracy, and compliance with federal policies. Medicare Reviewers may work for government agencies, private insurance companies, or healthcare organizations to prevent fraud and ensure proper billing. Strong attention to detail, knowledge of Medicare policies, and experience in medical coding or auditing are essential for this role.

What are the key skills and qualifications needed to thrive in the Medicare Reviewer position, and why are they important?

A successful Medicare Reviewer typically holds a healthcare-related degree and possesses a deep understanding of Medicare regulations, coding guidelines, and medical terminology. Experience with claims processing software, electronic health records (EHRs), and knowledge of CMS guidelines or certifications such as Certified Professional Coder (CPC) are often required. Strong attention to detail, analytical thinking, and clear written communication are essential soft skills in this role. Together, these skills ensure accurate claims evaluation, regulatory compliance, and effective communication with providers and payers.

What job makes $10,000 a month without a degree?

A Medicare reviewer typically earns between $3,000 and $6,000 per month, which is below $10,000. Jobs that can pay $10,000 or more monthly without a degree often include high-level sales roles, real estate agents with successful transactions, or specialized trades like certain construction or technical positions, but these usually require experience, certifications, or licenses rather than formal degrees.
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Medicare Reviewer jobs near you

Medical Reviewer III (Medicare/DRG)

Empower AI

Remote

Other

This job post has expired today. Applications are no longer accepted.

Job description

Medical Review Specialist III (Medicare DRG)

Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. The result is a government workforce that is exponentially more creative and productive.

As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis Related Group (DRG) claims. Perform projects or duties as assigned as a Medical Review Specialist. You will serve as a critical component in meeting our mission of providing excellent services to our clients. Your experience ensures an exciting and rewarding opportunity to be at the forefront of activities related to implementing healthcare reform on a national level. In assuming this position, you will be a critical contributor to meeting Empower AI's mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments.

Highlights of Responsibilities:

  • Perform comprehensive medical record and claims review to make payment determinations based on insurance coverage, coding, and utilization of services and practice guidelines for Medicare DRG.
  • Performs first level of Medical Review in determination of claims payment review.
  • Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
  • Utilize electronic health information imaging and input medical review decisions by electronic database module.
  • Utilize internet and intranet sources for policy verification.
  • Utilize Microsoft Office suite and other software templates as associated source input for claims review.
  • Make clinical judgment decisions based on clinical experience when applicable.
  • Responsible for review of Medicare DRG claims.
  • Meeting quality and production standards.
  • Ensuring departmental compliance with quality management system and ISO requirements.
  • Completes other projects or duties assigned by the Medical Review Lead Specialist

Requirements:

  • Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing. At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
  • At least three (3) years clinical experience as a Registered Nurse.
  • Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
  • Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
  • Ability to keep sensitive and confidential material private.
  • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).

Preferred Education and Experience:

  • Physician Office, Hospital, Supplier, or Clinic providing DME equipment care/services
  • Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance
  • Optional - Bilingual (Spanish) - Fluency in reading and understanding Spanish language especially as it relates to medical records is a plus!

Physical Requirements:

  • Sitting for long periods
  • Standing for long periods

All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm's overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor.

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