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Medicare Reviewer Jobs (NOW HIRING)

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 ...

CorroHealth

Medicare Specialist

Review patient bills for accuracy and completeness and obtaining any missing information. * Utilization and adherence to Medicare guidelines. * Other duties as assigned. MINIMUM QUALIFICATIONS ...

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How much do medicare reviewer jobs pay per hour?

As of Aug 12, 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.

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 billing, or health administration, along with knowledge of Medicare policies. Relevant certifications, like Certified Professional Coder (CPC) or healthcare compliance training, can enhance prospects. Experience with medical records review and familiarity with healthcare software are also beneficial.

What is a Medicare reviewer?

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 as a Medicare reviewer?

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.

More about Medicare Reviewer jobs
What cities are hiring for Medicare Reviewer jobs? Cities with the most Medicare Reviewer job openings:
What are the most commonly searched types of Medicare Reviewer jobs? The most popular types of Medicare Reviewer jobs are:
What states have the most Medicare Reviewer jobs? States with the most job openings for Medicare Reviewer jobs include:
What job categories do people searching Medicare Reviewer jobs look for? The top searched job categories for Medicare Reviewer jobs are:
Medicare Reviewer jobs near you
Infographic showing various Medicare Reviewer job openings in the United States as of August 2026, with employment types broken down into 76% Full Time, and 24% Part Time. Highlights an 89% In-person, 3% Hybrid, and 8% Remote job distribution, with an average salary of $62,159 per year, or $29.9 per hour.

Specialist, Medicare

Ovation Healthcare

Remote

Full-time

Re-posted 28 days ago

Job description

Welcome to Ovation Healthcare!
At Ovation Healthcare (formerly QHR Health), we've been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions.
The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.
We're looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare, you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork.
Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit www.ovationhc.com.
Summary:
The Medicare Specialist is responsible for managing the billing and collection processes for Medicare patients, ensuring compliance with Medicare policies and regulations, and following up on unpaid Medicare claims. This role involves processing Medicare claims, managing accounts receivable, addressing patient inquiries, and working closely with Medicare representatives to resolve billing issues.
Duties and Responsibilities:
  • Prepare and submit accurate Medicare claims for patient services, ensuring compliance with Medicare guidelines and regulations. Utilizes DDE, CWF, and other tools to identify, track and follow up on unpaid or denied Medicare claims, identifying issues and working to resolve any billing discrepancies with Medicare or patients.
  • 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 their Medicare coverage, billing questions, payment options, and any unpaid balances.
  • Investigate and resolve issues related to denied or underpaid Medicare claims, working with Medicare representatives and internal departments to ensure accurate reimbursement. Prepares and submits appeals for denied claims, including supporting documentation.
  • Monitor and analyze aging reports to prioritize follow-up actions for overdue Medicare accounts, ensuring timely resolution. Ensure all billing and collection practices are compliant with Medicare regulations, HIPAA, and company policies. Identifies potential compliance risks and recommends corrective action. Maintains accurate records of all Medicare claims, payments, communications, and follow-up activities, ensuring proper documentation in the patient account system.
  • Identify and resolve Medicare credit balances and may assist with preparation of quarterly Medicare credit balance report. Request offset to future payments in DDE.
  • Work with internal departments, such as coding, finance, etc. to review diagnosis, CPT code, etc. to resolve claim edit issues.
  • Prepare, submit, and follow up on redetermination appeals to Medicare

Knowledge, Skills, and Abilities:
  • Ability to analyze complex data, identify patterns, and draw accurate conclusions.
  • High level of accuracy in reviewing medical records and billing data.
  • Ability to analyze claim data, identify billing errors, and troubleshoot complex claim issues.
  • In-depth knowledge of Medicare billing codes, guidelines, and regulations. Familiarity with electronic health record (EHR) systems, billing software, and remittance advice processing and DDE. Strong communication skills, with the ability to explain Medicare billing details and resolve patient concerns effectively.
  • Ability to handle sensitive information and maintain confidentiality in accordance with HIPAA regulations. Detail-oriented with strong organizational skills and the ability to manage multiple accounts simultaneously. Problem-solving abilities, particularly with regard to billing discrepancies and denied claims.

Work Experience, Education, and Certifications:
  • Experience utilizing Payer portals, DDE and client systems
  • 3-5 years of hospital Business Office billing and follow-up experience as a Medicare representative. Medical Terminology, ICD-10, CPT and DRG knowledge a preferred, knowledge of third-party Insurance payer guidelines
  • High school diploma or equivalent

Working Conditions:
Work from home and remote location with a stable internet connection, a quiet and dedicated workspace free of distractions, and access to necessary office equipment. The ability to have daily communication with team members, management, and clients through email, phone calls, video meetings and other collaborative tools. Primarily requires sitting at a desk for extended period. Proper lighting and ergonomics shole be maintained to reduce eye strain.
100% Remote

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