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Clinical Pharmacist - Medicare

TX · Remote

$57 - $58/hr

In this remote role, you'll review pharmacy benefit requests, ensure compliance with CMS/Medicare guidelines, and provide clinical expertise while delivering a best-in-class service experience. Key ...

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How much do remote medicare reviewer jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for remote 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 is a remote Medicare reviewer?

A Remote Medicare Reviewer is a healthcare professional who evaluates medical records and claims to ensure they meet Medicare guidelines and compliance requirements. Working remotely, they review documentation submitted by healthcare providers to verify that services billed to Medicare are medically necessary and properly documented. Their role helps prevent fraud, waste, and abuse in the Medicare system, while ensuring accurate reimbursement for providers. This position typically requires a background in nursing, coding, or healthcare administration, along with knowledge of Medicare policies.

What are the key skills and qualifications needed to thrive as a remote Medicare reviewer?

To thrive as a Remote Medicare Reviewer, you generally need a background in nursing or healthcare, knowledge of Medicare guidelines, and relevant licensure such as an RN or LPN. Familiarity with claims review software, electronic medical records (EMR), and CMS regulations is typically required, and certifications in case management can be beneficial. Excellent attention to detail, strong analytical skills, and effective written communication help reviewers interpret medical records and document findings accurately. These skills are critical for ensuring compliance, preventing fraud, and supporting the integrity of Medicare services.

What are the most common challenges faced by remote Medicare reviewers, and how can they be managed effectively?

Remote Medicare Reviewers often encounter challenges such as interpreting complex medical documentation, staying updated with frequently changing Medicare guidelines, and managing high caseloads while working independently. To manage these effectively, it's important to develop strong time-management skills, actively participate in ongoing training, and utilize available resources such as clinical guidelines and team communication tools. Regular check-ins with team members and supervisors can also provide support and help resolve complex cases efficiently.

What is the difference between Remote Medicare Reviewer vs Remote Medical Coder?

AspectRemote Medicare ReviewerRemote Medical Coder
Required CredentialsCertifications like CMS Certification, medical backgroundCertified Coding Specialist (CCS), CPC, or equivalent
Work EnvironmentHome-based, healthcare insurance industryHome-based, healthcare billing and coding industry
Employer & Industry UsageInsurance companies, Medicare/Medicaid providersHospitals, clinics, billing companies
Comparison Search IntentUnderstanding roles in Medicare review processUnderstanding medical coding and billing roles

The Remote Medicare Reviewer and Remote Medical Coder roles share similarities in healthcare industry experience and certification requirements. However, the Medicare Reviewer focuses on evaluating Medicare claims and coverage, while the Medical Coder specializes in translating medical procedures into billing codes. Both roles are remote, industry-specific, and require relevant certifications, but they serve different functions within healthcare administration.

More about Remote Medicare Reviewer jobs

What cities are hiring for Remote Medicare Reviewer jobs?

Cities with the most Remote 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 Remote Medicare Reviewer jobs?

States with the most job openings for Remote Medicare Reviewer jobs include:

What are popular job titles related to Remote Medicare Reviewer jobs?

For Remote Medicare Reviewer jobs, the most frequently searched job titles are:

Remote Medicare Reviewer jobs near you
Infographic showing various Remote Medicare Reviewer job openings in the United States as of September 2026, with employment types broken down into 72% Full Time, 14% Part Time, and 14% Contract. Highlights an 100% Remote job distribution, with an average salary of $62,159 per year, or $29.9 per hour.

Medicare Clinical Appeals Reviewer - Remote (RN, PT, OT, RT)

Remote

St. George Tanaq Corporation
Business Management Consulting • 1 - 10 employees
Learn more about St. George Tanaq Corporationexternal

Other

Posted 22 days ago

Job description

Medicare Clinical Appeals Reviewer - Remote (RN, PT, OT, RT)

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 to support a contract with our federal client. The Appeals Professional III performs complex (senior-level) work. Provides dissatisfied parties with the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides an independent second-level determination based on the documentation, facts, laws, regulations, and guidelines for Medicare Part C appeals. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. While posted externally as a Medicare Clinical Appeals Reviewer III, this position is classified internally as an Appeals Professional III to meet contract requirements.

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.

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

  • Reviews 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.

  • Makes fair, impartial, and independent decisions based on current medical evidence, statutes, regulations, rulings, policies, and procedures.

  • Responds to and ensure that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.

  • Conducts 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.

  • Stays abreast of changes in regulations, medical and healthcare practices, policies, and procedures.

  • Participates in case-specific verbal discussions.

  • Conducts reviews of appeals/disputes involving multiple beneficiaries/services in a single case.

  • Plans responses to statistical analysis challenges with assistance from statisticians.

  • Attends meetings and participate in workgroups at management's direction.

  • Serves as a subject matter expert.

  • Mentors and/or trains staff.

  • Conducts quality reviews and audits, as needed.

  • Participates in special projects and perform other duties as assigned.

Requirements

Required Experience and Skills

  • Three (3) years of experience in medical dispute resolution, Medicare appeals, medical review, clinical work, or related healthcare roles.

  • Healthcare Professional with experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy experience.

  • Demonstrated experience writing or making medical necessity decisions.

  • Proficiency in research techniques, medical terminology, and analyzing and interpreting policies, along with knowledge of state and federal laws and regulations.

  • Must have experience and working knowledge of the Medicare program, including coverage and payment rules.

  • Experience with Medicare regulations, claims processing, and the medical review process, as well as applicable laws, rules, and regulations.

  • Prioritize and organize work tasks to handle multitasking and meet deadlines.

  • Ability to prepare correspondence and documents using correct spelling, grammar, and punctuation; proofreading and reviewing documents for clarity and consistency.

  • Practice logic and reasoning to identify problems, verify facts, and reach valid conclusions.

  • Experience in making decisions that support business objectives and goals.

  • Ability to identify and resolve problems or refer issues appropriately.

  • Communicate effectively verbally and in writing.

  • Adapt to the needs of internal and external customers.

  • Show integrity and ethical behavior, respect confidentiality, business ethics, and organizational standards.

  • Ensure compliance with company policies, procedures, and guidelines, including cybersecurity, regulatory, contractual, and accreditation entities.

  • Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred.

  • Must have resided in the United States for a minimum of three (3) years out of the last five (5) years. This is a contractual requirement.

  • Must possess a valid driver's license with a clear and satisfactory driving record.

  • Ability to obtain and maintain public trust clearance and customer approval.

  • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Education and Training

  • Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline.

  • Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for an Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Physical Requirements

  • Requires working in an office/cubicle environment; sitting, standing, walking, bending, twisting, and/or reaching.

  • Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.

  • May require the ability to operate a motor vehicle and travel by motor vehicle and commercial airline. May require overnight travel. Travel may be less than 5% annually.

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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