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Remote Medical Reviewer Jobs in Sumter, SC (NOW HIRING)

Veristat

Principal Medical Writer

Columbia, SC · On-site +1

Benefits vary by location and may include: o Remote working o Flexible time off o Paid holidays o ... Automated Decision Making: All applicants are reviewed by a member of the Veristat Talent ...

Veristat

Principal Medical Writer

Columbia, SC · On-site +1

Benefits vary by location and may include: o Remote working o Flexible time off o Paid holidays o ... Automated Decision Making: All applicants are reviewed by a member of the Veristat Talent ...

Encompass Health

Remote Pharmacist

Columbia, SC · Remote

$54 - $64.75/hr

Affordable medical, dental, and vision plans for both full-time and part-time employees and their ... Reviews system alerts for drug interactions, allergies, order & therapy duplications, over-dose ...

micro1 AI

Medical Writing Manager

Columbia, SC · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Author and review realistic evaluation tasks based on Clinical Study Reports, DSURs, PSURs/PBRERs ...

micro1 AI

Medical Billing Specialist

Columbia, SC · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Author and review realistic evaluation tasks based on Clinical Study Reports, DSURs, PSURs/PBRERs ...

Ourhrconnect

Quality Medical Auditor

Columbia, SC · Remote

... remote work. What You'll Do: * Determines methodology to identify cases for validation review ... Extensive medical records and coding knowledge. Working knowledge of contract evaluations, claims ...

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All JobsMedical Reviewer JobsRemote Medical Reviewer JobsRemote Medical Reviewer Jobs in Sumter, SC

Remote Medical Reviewer information

See Sumter, SC salary details

$10

$37

$89

How much do remote medical reviewer jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for remote medical reviewer in Sumter, SC is $37.45, according to ZipRecruiter salary data. Most workers in this role earn between $20.34 and $48.17 per hour, depending on experience, location, and employer.

What is a remote medical reviewer?

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 as a remote medical reviewer?

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 are popular job titles related to Remote Medical Reviewer jobs in Sumter, SC? For Remote Medical Reviewer jobs in Sumter, SC, the most frequently searched job titles are:
What cities near Sumter, SC are hiring for Remote Medical Reviewer jobs? Cities near Sumter, SC with the most Remote Medical Reviewer job openings:
Remote Medical Reviewer jobs near you
Infographic showing various Remote Medical Reviewer job openings in Sumter, SC as of August 2026, with employment types broken down into 1% As Needed, 69% Full Time, 24% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $77,904 per year, or $37.5 per hour.

Business Analyst (Policy remediation) - Contract - Remote

SUNSHINE ENTERPRISE USA LLC

Columbia, SC • Remote

Contractor

Re-posted 14 days ago

Job description

Business Analyst (Policy remediation) Location: Remote Interview Process: 1 round, virtual Duration: 12 Months Employment Type: Contract Experience Required: 05+ Years Candidate Location: Candidate MUST be a SC resident. No relocation allowed. Project Scope: We are seeking an experienced Business Analyst with expertise in policy remediation, medical coding, and healthcare claims systems.

This role will serve as a subject matter expert (SME) supporting policy and operational initiatives related to medical coding compliance, claims adjudication, and system change management. The ideal candidate will leverage deep knowledge of ICD-10, CPT, and HCPCS coding methodologies, as well as Medicaid and payer operations, to ensure alignment between policy updates, coding changes, and system functionality. This position will play a critical role in supporting compliance initiatives, regulatory updates, and business process improvements.

Key Responsibilities: Serve as a subject matter expert (SME) for medical coding methodologies, Medicaid policy, and claims adjudication processes. Analyze annual, quarterly, and ad hoc coding updates, including ICD-10, CPT, and HCPCS changes. Review and assess the impact of coding and policy changes on business processes, system functionality, and claims outcomes.

Collaborate with business stakeholders, policy teams, and technical teams to define requirements and implement necessary system changes. Support change requests and ensure system updates produce accurate and expected claims adjudication results. Research business rules, requirements, and process models to develop recommendations and solutions.

Maintain and update business rules, requirements documentation, and process models in designated repositories. Lead meetings with stakeholders, business owners, and cross-functional teams. Participate in policy remediation efforts, compliance initiatives, and related enterprise projects.

Ensure process documentation, training materials, and supporting documentation are complete and up to date. Collaborate with internal teams to support ongoing operational and regulatory compliance. Provide expertise in medical coding software, claims systems, and healthcare policy interpretation.

Required Skills & Experience: Minimum of 5 years of experience in healthcare insurance, medical review, program integrity, or appeals. At least 5 years of experience working with IT developers and programmers in a payer environment. Minimum of 5 years of hands-on experience in medical coding within a payer environment.

Strong expertise in ICD-10, CPT, and HCPCS coding methodologies and translation. Minimum of 5 years of experience with medical claims processing systems. Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint).

Experience using Optum Encoder or similar medical coding software. Strong analytical, problem-solving, and critical-thinking skills. Excellent written and verbal communication skills.

Preferred Skills: Minimum of 5 years of experience in policy remediation. At least 3 years of clinical experience in a healthcare environment. Strong clinical assessment and critical-thinking skills.

Experience with Medicaid programs and Medicaid Management Information Systems (MMIS). Familiarity with healthcare regulatory compliance and policy implementation. Technical Skills Medical Coding and Reimbursement, ICD-10, CPT, and HCPCS Expertise, Policy Remediation and Compliance, Claims Adjudication and Processing, Medicaid and MMIS Knowledge, Business Requirements Analysis, Process Documentation and Improvement, Stakeholder Engagement and Facilitation, Regulatory and Operational Compliance, Cross-Functional Collaboration Education: Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field.

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