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Remote Medical Reviewer Jobs in Springfield, OH (NOW HIRING)

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

In addition the team lead, will review coding & charges, ensure the completion of team members ... The Medical Billing Specialist Team Leader is responsible for the entry of all data processed ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

In addition the team lead, will review coding & charges, ensure the completion of team members ... The Medical Billing Specialist Team Leader is responsible for the entry of all data processed ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

In addition the team lead, will review coding & charges, ensure the completion of team members ... The Medical Billing Specialist Team Leader is responsible for the entry of all data processed ...

Premier Health

LEAD MEDICAL BILLING SPEC-REMOTE

Moraine, OH · On-site +1

$16.50 - $21/hr

In addition the team lead, will review coding & charges, ensure the completion of team members ... The Medical Billing Specialist Team Leader is responsible for the entry of all data processed ...

Premier Health

PATIENT ACCESS SPECIALIST - REMOTE

Dayton, OH · Remote

$16.75 - $22.25/hr

... reviewing orders for compliancy, completion of MSP, obtaining financial and treatment consents ... ordered medical procedures, obtaining a pre-certification when applicable while maintaining ...

Premier Health

PATIENT ACCESS SPECIALIST - REMOTE

Dayton, OH · Remote

$16.75 - $22.25/hr

... reviewing orders for compliancy, completion of MSP, obtaining financial and treatment consents ... ordered medical procedures, obtaining a pre-certification when applicable while maintaining ...

Deloitte

Hospital Billing Operator

Dayton, OH · Remote

$17.75 - $22.75/hr

As an Epic Hospital Billing Analyst, you will help review and submit hospital claims, resolve billing issues, and work across teams to reduce avoidable denials. This is a primarily remote role ...

Deloitte

Epic Denials Management Operator

Dayton, OH · Remote

$17.50 - $23.25/hr

This is a primarily remote role supporting enterprise Epic support, with minimal travel and ... Review hospital account records and payer remittance records, communicate with relevant Client RCM ...

Pacs

Interim Biller 6 Months

Spring Valley, OH · Remote

$35 - $36/hr

Fresno, CA (Open to Remote location Central Valley) Full-Time Pay Range: $35-$36+/hour (BOE) Join ... Review and reconcile billing reports and documentation Maintain compliance with federal, state, and ...

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Remote Medical Reviewer information

See Springfield, OH salary details

$10

$37

$90

How much do remote medical reviewer jobs pay per hour?

As of Aug 2, 2026, the average hourly pay for remote medical reviewer in Springfield, OH is $37.88, according to ZipRecruiter salary data. Most workers in this role earn between $20.58 and $48.70 per hour, depending on experience, location, and employer.

What is a Remote Medical Reviewer job?

A Remote Medical Reviewer evaluates medical records, claims, or cases to ensure accuracy, compliance, and appropriate medical decision-making. They typically work for insurance companies, healthcare organizations, or third-party review agencies. This role involves analyzing documentation, applying clinical guidelines, and providing recommendations based on medical expertise. It requires a background in healthcare, such as nursing or medicine, along with strong analytical and communication skills. The job is performed remotely, allowing flexibility while maintaining high standards of medical review.

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

A Remote Medical Reviewer requires a strong background in healthcare, such as a nursing or pharmaceutical degree, along with in-depth knowledge of clinical guidelines and regulatory standards. Familiarity with electronic medical record (EMR) systems, coding software, and industry certifications like RHIA or CCS is often necessary. Exceptional attention to detail, analytical thinking, and clear written communication are vital soft skills for this role. These competencies ensure accurate and timely medical review decisions that impact patient care and regulatory compliance.

What are some common challenges faced by Remote Medical Reviewers and how can they be addressed?

Remote Medical Reviewers often encounter challenges such as reviewing complex cases with limited background information and keeping up with frequent updates to medical regulations and insurance policies. Staying organized, participating in continuing education, and leveraging robust digital communication tools can help you overcome these obstacles. You'll also need to be self-motivated and comfortable working independently, as remote teams often collaborate primarily through virtual meetings and secure documentation platforms. Embracing strong time management practices and regularly connecting with colleagues for case discussions can greatly enhance your job performance and satisfaction.

What job categories do people searching Remote Medical Reviewer jobs in Springfield, OH look for? The top searched job categories for Remote Medical Reviewer jobs in Springfield, OH are:
What cities near Springfield, OH are hiring for Remote Medical Reviewer jobs? Cities near Springfield, OH with the most Remote Medical Reviewer job openings:
Remote Medical Reviewer jobs near you

Medical Director (REMOTE Appeals Medical Director - Pacific Standard Time, Managed Care Experience,

CareSource

Dayton, OH • On-site, Remote

$195K - $341K/yr

Full-time

Re-posted 3 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

201st of 301 rated insurance

Job description

Job Summary:
The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members.
Essential Functions:
  • Provide prior authorization medical reviews, consultation and clinical review services
  • Participate in peer-to-peer discussions
  • Provide provider education, training, data sharing, performance evaluations and orientation to the plan
  • Conduct clinical reviews for designated CareSource members as requested
  • Provide physician review for clinical appeals cases
  • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
  • Participate in development of policies and procedures
  • Participates in quality improvement initiatives, case management activities and member safety activities (i.e. incident management
  • Provide cross-coverage for other Medical Directors and/or markets, as needed
  • Oversight and quality improvement activities associated with case management activities
  • Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
  • Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
  • Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
  • Collaborate with market/product leaders to help define market strategy
  • Community collaborative participation
  • Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for all programs
  • Perform any other job related instructions, as requested

Education and Experience:
  • Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
  • Successful completion of a residency training program, preferably in primary care is required
  • Minimum of five (5) years of clinical practice experience is required
  • Managed care medical review/medical director experience is preferred
  • Bachelor's or Master's degree in Business Administration, Operational Excellence, Healthcare Administration or Medical Management is preferred

Competencies, Knowledge and Skills:
  • Basic Microsoft Word skills
  • Excellent communication skills, both written and oral
  • Ability to work well independently and within a team environment
  • Ability to create strong relationships with Providers and Members
  • High ethical standards
  • Attention to detail
  • Critical listening and systematic thinking skills
  • Ability to maintain confidentiality and act in the company's best interest
  • Ability to act with diplomacy and sensitivity to cultural diversity
  • Decision making/problem solving skills
  • Conflict resolution skills
  • Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served

Licensure and Certification:
  • Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
  • Board Certification, preferably in primary care specialty is required
  • Re-certification, as required by specialty board, must be maintained (exceptions may be granted by Chief Medical Officer)
  • MCG Certification is required or must be obtained within six (6) months of hire

Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • May be required to work evenings/weekends
  • May be required to travel to fulfill duties of position

Compensation Range:
$195,200.00 - $341,600.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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