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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.

Medicare Clinical Appeals Reviewer III

St. George Tanaq Corporation

Charleston, WV • On-site

Other

Posted 22 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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