Clinical Review & Medical Documentation Specialist

𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗥𝗲𝘃𝗶𝗲𝘄 & 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗗𝗼𝗰𝘂𝗺𝗲𝗻𝘁𝗮𝘁𝗶𝗼𝗻 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁
Remote | Independent Contractor | India
𝗔𝗯𝗼𝘂𝘁 𝗔𝗴𝗲𝗻𝘁𝘀 𝗢𝗻𝗹𝘆 𝗧𝗲𝗰𝗵𝗻𝗼𝗹𝗼𝗴𝗶𝗲𝘀 𝗜𝗻𝗰.
Agents Only Technologies Inc. is a global workforce and operations company supporting technology, healthcare, customer experience, business operations, and professional services across multiple industries. We collaborate with organizations worldwide to deliver high-quality solutions through distributed networks, structured processes, and a commitment to operational excellence.
Our global network of healthcare professionals supports specialized clinical review, medical documentation, utilization management, and healthcare content projects requiring strong subject-matter expertise and attention to detail.
𝗥𝗼𝗹𝗲 𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄
We are seeking experienced healthcare professionals in India to support a specialized project with 𝘁𝗵𝗿𝗲𝗲 𝗱𝗶𝘀𝘁𝗶𝗻𝗰𝘁 𝗮𝗿𝗲𝗮𝘀 𝗼𝗳 𝗲𝘅𝗽𝗲𝗿𝘁𝗶𝘀𝗲: Prior Authorization Review, Prior Authorization & Appeals Preparation, and Medical Record Synthesis.
Depending on your professional background, you may be considered for 𝗧𝗶𝗲𝗿 𝟭, 𝗧𝗶𝗲𝗿 𝟮, 𝗼𝗿 𝗧𝗶𝗲𝗿 𝟯 assignments.
𝗧𝗶𝗲𝗿 𝟭 – 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 & 𝗨𝘁𝗶𝗹𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗥𝗲𝘃𝗶𝗲𝘄 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁
𝗥𝗼𝗹𝗲 𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄
This role focuses on developing and evaluating realistic prior-authorization scenarios requiring clinical judgment and medical-necessity review. Contributors will apply utilization management principles and CMS coverage policies to determine whether a request should be 𝗔𝗽𝗽𝗿𝗼𝘃𝗲𝗱, 𝗗𝗲𝗻𝗶𝗲𝗱, 𝗼𝗿 𝗿𝗲𝘁𝘂𝗿𝗻𝗲𝗱 𝗳𝗼𝗿 𝗠𝗼𝗿𝗲 𝗜𝗻𝗳𝗼𝗿𝗺𝗮𝘁𝗶𝗼𝗻.
𝗔𝘀 𝗮 𝗧𝗶𝗲𝗿 𝟭 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁, 𝘆𝗼𝘂 𝘄𝗶𝗹𝗹:
• Author prior-authorization scenarios covering routine, complex, and safety-critical cases.
• Develop scenarios across specialties such as radiology, surgery, cardiology, behavioral health, sleep studies, radiation therapy, spine/orthopedics, and DME.
• Create gold-standard Approve / Deny / Request More Information recommendations.
• Apply applicable CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
• Evaluate whether documentation supports medical necessity.
• Model appropriate Request More Information decisions when documentation is incomplete.
• Create evaluation rubrics assessing clinical reasoning and correct application of coverage policies.
• Participate in iterative review and evaluation cycles.
𝗥𝗲𝗾𝘂𝗶𝗿𝗲𝗱 𝗤𝘂𝗮𝗹𝗶𝗳𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀
• Active RN license or MD/DO qualification.
• 3+ years of experience in utilization management, prior authorization, case management, or payer-side medical review.
• Working knowledge of CMS NCD/LCD coverage determinations.
• Understanding of medical-necessity review standards.
• Ability to work across multiple clinical specialties.
• Strong clinical reasoning and documentation skills.
𝗣𝗿𝗲𝗳𝗲𝗿𝗿𝗲𝗱
• Peer-to-peer review experience.
• CPUR, ACM, or equivalent UM certification.
• Experience with clinical content authoring, data annotation, or evaluation projects.
𝗧𝗶𝗲𝗿 𝟮 – 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 & 𝗔𝗽𝗽𝗲𝗮𝗹𝘀 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁
𝗥𝗼𝗹𝗲 𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄
This role focuses on the evidence-gathering and appeals preparation side of clinical review. Contributors will develop prior-authorization evidence packets and create physician-level appeal documentation demonstrating medical necessity following a denial.
𝗔𝘀 𝗮 𝗧𝗶𝗲𝗿 𝟮 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁, 𝘆𝗼𝘂 𝘄𝗶𝗹𝗹:
• Author scenarios requiring assembly of complete prior-authorization evidence packets.
• Review patient chart information and identify documentation supporting medical necessity.
• Draft gold-standard physician appeal letters addressing medical-necessity denials.
• Apply relevant CMS NCD/LCD requirements to appeal arguments.
• Research and cite relevant peer-reviewed medical literature, including PubMed sources.
• Ensure citations are current, relevant, and directly support the clinical argument.
• Create evaluation rubrics assessing evidence completeness and appeal quality.
• Evaluate the strength, accuracy, and documentation of clinical arguments.
• Participate in iterative content review and evaluation cycles.
𝗥𝗲𝗾𝘂𝗶𝗿𝗲𝗱 𝗤𝘂𝗮𝗹𝗶𝗳𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀
• RN, MD/DO, or relevant clinical documentation professional qualification.
• 3+ years of experience in prior authorization, utilization review, clinical documentation, or denials and appeals.
• Working knowledge of CMS NCD/LCD medical-necessity standards.
• Experience reviewing clinical documentation.
• Ability to research and cite peer-reviewed medical literature.
• Strong persuasive and evidence-based medical writing skills.
𝗣𝗿𝗲𝗳𝗲𝗿𝗿𝗲𝗱
• Experience drafting actual payer appeal letters.
• Experience working in a denials and appeals department.
• Familiarity with literature search and evidence grading.
• Experience with clinical content authoring or healthcare data projects.
𝗧𝗶𝗲𝗿 𝟯 – 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗥𝗲𝗰𝗼𝗿𝗱 𝗦𝘆𝗻𝘁𝗵𝗲𝘀𝗶𝘀 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁
𝗥𝗼𝗹𝗲 𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄
This role focuses on transforming complex, multi-visit medical records into accurate, chronological, and traceable clinical summaries. Contributors will review patient histories, identify clinically relevant patterns and redundant testing, and ensure each summary point can be linked back to its source documentation.
𝗔𝘀 𝗮 𝗧𝗶𝗲𝗿 𝟯 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁, 𝘆𝗼𝘂 𝘄𝗶𝗹𝗹:
• Author realistic multi-visit patient chart scenarios.
• Work with structured clinical data such as C-CDA XML and/or FHIR-formatted records.
• Create gold-standard chronological summaries of complex medical histories.
• Synthesize information across multiple encounters and clinical documentation sources.
• Identify duplicate or potentially redundant imaging, such as repeated CT or MRI studies within relevant time periods.
• Ensure every important summary point is traceable to a specific source chart note.
• Develop evaluation rubrics assessing summary completeness, accuracy, chronology, and source linkage.
• Review and refine clinical summaries through multiple evaluation cycles.
• Apply strong HIM/CDI principles when organizing and interpreting medical records.
𝗥𝗲𝗾𝘂𝗶𝗿𝗲𝗱 𝗤𝘂𝗮𝗹𝗶𝗳𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀
• Background in Health Information Management (HIM), Clinical Documentation Improvement (CDI), or a related discipline.
• 3+ years of relevant professional experience.
• Experience reviewing multi-encounter medical records.
• Strong medical summarization and structured-writing skills.
• Experience identifying clinically redundant or repeated testing.
• Working knowledge of C-CDA XML and/or FHIR clinical data structures.
𝗣𝗿𝗲𝗳𝗲𝗿𝗿𝗲𝗱
• RHIA or RHIT certification.
• CDIP or CCDS certification.
• Familiarity with HEDIS/MIPS quality measures.
• Experience with clinical data annotation, content authoring, or evaluation projects.
𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 / 𝗘𝘅𝗽𝗲𝗿𝘁𝗶𝘀𝗲
Candidates with educational background or professional experience in one or more of the following areas are encouraged to apply:
• Nursing
• Medicine
• Health Information Management
• Clinical Documentation Improvement
• Clinical Informatics
• Utilization Management
• Medical Review
• Healthcare Administration
• Related healthcare disciplines
Equivalent professional experience may also be considered.
𝗝𝗼𝗯 𝗗𝗲𝘁𝗮𝗶𝗹𝘀
• 𝗧𝘆𝗽𝗲: Independent Contractor
• 𝗠𝗮𝗿𝗸𝗲𝘁: India
• 𝗟𝗼𝗰𝗮𝘁𝗶𝗼𝗻: Remote
• 𝗖𝗼𝗺𝗽𝗲𝗻𝘀𝗮𝘁𝗶𝗼𝗻: Paid hourly
• 𝗦𝘁𝗮𝗿𝘁 𝗗𝗮𝘁𝗲: Based on project requirements
• 𝗢𝗽𝗲𝗻𝗶𝗻𝗴𝘀: Project-based and subject to client demand
𝗜𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 𝗡𝗼𝘁𝗲𝘀
• Candidates may be considered for one or more tiers based on their professional background and project requirements.
• Each tier requires strong attention to clinical accuracy, documentation quality, and adherence to project guidelines.
• Assignments may involve developing reference content, evaluation rubrics, clinical scenarios, or reviewing and improving existing materials.
• Project scope and task availability may vary based on business requirements.
𝗪𝗼𝗿𝗸 𝗔𝗿𝗿𝗮𝗻𝗴𝗲𝗺𝗲𝗻𝘁
• 𝗟𝗼𝗰𝗮𝘁𝗶𝗼𝗻: Remote
• 𝗪𝗼𝗿𝗸 𝗧𝘆𝗽𝗲: Independent Contractor
• 𝗦𝗰𝗵𝗲𝗱𝘂𝗹𝗲: Project-dependent / Flexible
• 𝗦𝗰𝗼𝗽𝗲: India
𝗖𝗼𝗺𝗽𝗲𝗻𝘀𝗮𝘁𝗶𝗼𝗻
Actual earnings may vary based on task availability, productivity, quality performance, project requirements, certifications, domain expertise, and business needs.
𝗛𝗼𝘄 𝘁𝗼 𝗔𝗽𝗽𝗹𝘆
Interested candidates may submit their application through the official application process.
Please indicate your relevant area of expertise, such as Prior Authorization / Utilization Management, Appeals & Denials, or HIM / CDI / Medical Record Synthesis, and ensure your profile accurately reflects your professional experience and certifications.
Only shortlisted candidates will be contacted.
𝗘𝗾𝘂𝗮𝗹 𝗢𝗽𝗽𝗼𝗿𝘁𝘂𝗻𝗶𝘁𝘆
Agents Only Technologies Inc. is committed to fostering an inclusive and diverse global community. We welcome talented individuals from a wide range of backgrounds, experiences, and perspectives. Opportunities are made available based on qualifications, skills, experience, and business needs, with the goal of building a collaborative environment where contributors can learn, grow, and succeed together.

Work arrangement
Yes