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Physician Insurance Reviewer Jobs (NOW HIRING)

The US Oncology Network

Insurance Reviewer

Eugene, OR · On-site

$22 - $32/hr

Overview Insurance Reviewer - Clinical Willamette Valley Cancer Institute is looking for an ... Communicate with nursing, physician, pharmacists and medical staff to inform them of any ...

Springfield Clinic

Insurance Reviewer II

Springfield, IL · On-site

$18.22 - $26.42/hr

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment ... Analyze and process front-end system edits for correct physician productivity and billing of claims.

Springfield Clinic

Insurance Reviewer II

Springfield, IL · On-site

$18.22 - $26.42/hr

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment ... Analyze and process front-end system edits for correct physician productivity and billing of claims.

Inova

Physician Insurance Analyst 4

Falls Church, VA · On-site

$19.70 - $29.55/hr

Inova is Looking for a dedicated Physician Insurance Analyst to join the team. This role will be ... charge reviews and claim edits. Assure all assigned claims meet clearinghouse and/or payer ...

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Physician Insurance Reviewer information

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How much do physician insurance reviewer jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for physician insurance reviewer in the United States is $32.48, according to ZipRecruiter salary data. Most workers in this role earn between $15.14 and $33.65 per hour, depending on experience, location, and employer.

What is a physician insurance reviewer?

Physician Insurance Reviewers are licensed medical doctors who evaluate insurance claims to determine the medical necessity and appropriateness of healthcare services. They review patient records, treatment plans, and diagnostic results to ensure that the care provided aligns with established guidelines and insurance policies. Their assessments help insurers decide whether to approve or deny coverage for specific procedures, medications, or treatments. These professionals play a crucial role in balancing patient care needs with cost management, and they often consult with treating physicians to clarify clinical details.

What are the key skills and qualifications needed to thrive as a physician insurance reviewer?

To thrive as a Physician Insurance Reviewer, you need a medical degree (MD or DO), clinical experience, and knowledge of healthcare regulations and insurance policies. Familiarity with electronic medical records (EMR) systems, utilization review software, and relevant certifications like URAC or CM review are typically required. Strong analytical thinking, attention to detail, and effective written and verbal communication skills help ensure accurate and fair assessments. These competencies are crucial for making informed coverage decisions that balance patient care with compliance and cost efficiency.

What are some common challenges physician insurance reviewers face when assessing complex medical cases?

Physician Insurance Reviewers often encounter challenges when reviewing cases that involve rare conditions, ambiguous documentation, or conflicting medical opinions. Balancing the need for thorough, evidence-based review with strict deadlines can be demanding, especially when communicating decisions to healthcare providers or patients. Staying current with evolving clinical guidelines and payer policies is also essential to make fair and accurate determinations. Collaboration with multidisciplinary teams and clear documentation are key strategies to address these challenges effectively.

What is the difference between Physician Insurance Reviewer vs Medical Claims Processor?

AspectPhysician Insurance ReviewerMedical Claims Processor
Required CredentialsMedical degree, licensing, insurance knowledgeHigh school diploma or equivalent, insurance training
Work EnvironmentInsurance companies, healthcare organizationsInsurance companies, healthcare providers
Job FocusReviewing medical records for insurance claimsProcessing and entering insurance claims
Common Search IntentDifferences, responsibilities, qualificationsJob duties, salary, requirements

The main difference is that Physician Insurance Reviewers evaluate medical records to determine insurance coverage, requiring medical credentials and insurance knowledge. Medical Claims Processors handle the administrative task of processing claims, often with less medical training. Both roles are essential in the insurance and healthcare industry but focus on different aspects of claims management.

More about Physician Insurance Reviewer jobs

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What states have the most Physician Insurance Reviewer jobs?

States with the most job openings for Physician Insurance Reviewer jobs include:

What job categories do people searching Physician Insurance Reviewer jobs look for?

The top searched job categories for Physician Insurance Reviewer jobs are:

Physician Insurance Reviewer jobs near you
Infographic showing various Physician Insurance Reviewer job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 20% Part Time, and 6% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $67,549 per year, or $32.5 per hour.

Insurance Reviewer

The US Oncology Network

Eugene, OR • On-site

$22 - $32/hr

Full-time

Life, Retirement

Re-posted 27 days ago

US Oncology rating

7.1

Company rating: 7.1 out of 10

Based on 109 frontline employees who took The Breakroom Quiz

380th of 896 rated healthcare providers

Job description

Overview
Insurance Reviewer - Clinical
Willamette Valley Cancer Institute is looking for an Insurance Reviewer to support our patients receiving testing and treatment needed for their diagnosis by navigating insurance portals and obtaining all appropriate authorizations. With a focus on authorizations for infusion drugs, radiation therapy, imaging, genetics and surgeries our Insurance Reviewers pave the way for our patients and treatment team to follow the prescribed treatment pathway. An individual that thrives in a high-volume workspace, with the ability to manage shifting priorities will find success in this role.
The general pay scale for this position at WVCI is $22.00-$32.00. The actual hiring rate is dependent on many factors, including but not limited to: prior work experience, education, job/position responsibilities, location, work performance, internal equity, etc.
Employment Type: Full Time
Benefits: M/D/V, Life Ins., 401(k)
Location: Eugene, OR
Responsibilities
  • Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Documentation of regimen related to pathway adherence and payer guidelines.
  • Communicate with nursing, physician, pharmacists and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
  • Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis
  • Obtains insurance authorization and pre-certification for various oncology & hematology related services.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
  • Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records.
  • Other duties as requested or assigned.

Qualifications
  • High school degree or equivalent.
  • Minimum three (3) years of prior authorization experience required. Revenue cycle experience preferred.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
WORK ENVIORNMENT:
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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