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Remote Medicare Reviewer Jobs (NOW HIRING)

ICONMA

Pharmacist - Clinical Pharmacist Advisor Medicare

$59.50 - $71.75/hr

... remote location. Responsibilities: * The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for ...

Mercor

Medicare Advantage Insight Contributor

New York, NY · Remote

$120/hr

Remote Duration: Approximately 20 minutes Role Responsibilities * Complete a structured ~20-minute ... Our team reviews applications daily. Please complete your AI interview and application steps to be ...

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Mercor

Medicare Advantage Broker - Expert

New York, NY · Remote

$140/hr

Remote Duration: 20 minutes Role Responsibilities * Complete a structured ~20-minute online survey ... Our team reviews applications daily. Please complete your AI interview and application steps to be ...

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How much do remote medicare reviewer jobs pay per hour?

As of Aug 23, 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 job categories do people searching Remote Medicare Reviewer jobs look for?

The top searched job categories for Remote Medicare Reviewer jobs are:

Remote Medicare Reviewer jobs near you
Infographic showing various Remote Medicare Reviewer job openings in the United States as of August 2026, with employment types broken down into 5% As Needed, 77% Full Time, 14% Part Time, and 4% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $62,159 per year, or $29.9 per hour.

Medical Reviewer (Radiologist) - Remote CA

Gainwell Technologies LLC

West Sacramento, CA • Remote

$150K - $175K/yr

Full-time

Medical, Life, Retirement, PTO

Posted yesterday

New

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

139th of 246 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies is seeking a Medical Reviewer (Radiologist) to provide physician-level radiology expertise supporting Medical Review Services for California healthcare programs. In this role, you will review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation to help ensure services meet applicable medical necessity, coverage, and program requirements.

Your role in our mission
  • Review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation.
  • Evaluate imaging and radiology services based on applicable medical policies, coverage requirements, and clinical standards.
  • Provide physician-level medical review and clinical expertise for complex radiology cases.
  • Support medical necessity and appropriateness determinations for requested or billed radiology services.
  • Document review findings, decisions, and supporting clinical rationale clearly and accurately.
  • Refer or collaborate on cases requiring additional clinical expertise when appropriate.
  • Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners.
  • Maintain knowledge of applicable radiology standards, medical policies, coverage requirements, and regulatory guidelines.
  • Meet established quality, accuracy, productivity, and turnaround-time expectations.
What we're looking for
  • Minimum of three (3) years of experience as a Radiologist in a private, academic, or government setting.
  • Current, non-expired physician license from the State of California, in good standing.
  • Must not be under suspension from Medicare, Medicaid, or practice in California.
  • Must not have been previously sanctioned for fraud or abuse.
  • Strong oral and written communication skills.
  • Strong clinical judgment and ability to interpret complex radiology-related medical records and supporting documentation.
What you should expect in this role
  • Full-time position.
  • Remote work environment.
  • Monday through Friday work schedule.
  • Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
  • Spend the majority of your day reviewing radiology-related medical records, claims, authorization requests, imaging documentation, and supporting clinical information.
  • Work independently while collaborating with physicians, nurses, other clinical specialists, operations teams, and business partners.
  • Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
  • Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status.
  • Maintain knowledge of applicable medical policies, coverage requirements, radiology standards, and regulatory guidelines.
  • Meet established quality, accuracy, productivity, and turnaround-time expectations.
  • Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.

#LI-REMOTE

#LI-MA1

The pay range for this position is $150,000 - $175,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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Benefits

Hours and flexibility

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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