Healthcare Domain Expert – Clinical Quality & Evaluation

Healthcare Domain Expert – Clinical Quality & Evaluation
Remote | Independent Contractor | Philippines
About Agents Only Technologies Inc.
Agents Only Technologies Inc. is a global workforce and operations company supporting technology, customer experience, business operations, and professional services across multiple industries. We collaborate with organizations worldwide to deliver high-quality solutions through distributed processes, specialized expertise, and a commitment to operational excellence.
Our global network of contributors supports projects that require specialized professional knowledge, careful evaluation, and high standards of quality and accuracy.
Role Overview
Agents Only Technologies Inc. is seeking experienced Healthcare Domain Experts in the Philippines to support a healthcare quality optimization project.
In this role, you will apply your professional healthcare expertise to curate high-fidelity clinical and operational test cases, review healthcare-focused skills, validate evaluation results, and help establish quality standards for healthcare workflows.
The role requires strong knowledge of clinical workflows, medical coding, payer operations, healthcare documentation, and regulatory or compliance requirements. Strong attention to clinical accuracy, patient safety, evidence-based reasoning, and documentation quality is essential.
As a Healthcare Domain Expert, you will:
• Curate and develop high-fidelity clinical and operational test cases based on professional healthcare experience.
• Create structured evaluation datasets for healthcare-focused skills and workflows.
• Develop representative input artifacts such as synthetic patient charts, clinical notes, payer benefit documents, and healthcare records.
• Create grounded prompts and corresponding expected outputs for healthcare scenarios.
• Establish clinician-verified gold-standard responses and evaluation criteria.
• Review healthcare skills and identify issues related to clinical accuracy, safety, completeness, and workflow adherence.
• Review and compare evaluation results across multiple development iterations.
• Develop objective rubrics, verification guidelines, and evaluation logic for measuring healthcare quality.
• Assess healthcare workflows involving payer operations, prior authorization, appeals, medical records, coding, medication safety, clinical documentation, and patient care processes.
• Validate that outputs appropriately follow applicable healthcare standards, policies, and safety requirements.
• Apply professional judgment to identify inaccuracies, omissions, unsupported conclusions, and potential safety concerns.
• Provide structured feedback and recommendations to support continuous quality improvement.
• Maintain a high level of accuracy, consistency, confidentiality, and professional judgment throughout the engagement.
Experience & Expertise
Candidates with professional healthcare experience and strong subject matter expertise in one or more of the following areas are encouraged to apply:
• Clinical workflows and healthcare operations
• Medical coding and healthcare documentation
• Utilization management and prior authorization
• Payer operations and insurance processes
• Appeals and medical necessity review
• Health Information Management (HIM)
• Clinical Documentation Improvement (CDI)
• Nursing or clinical practice
• Physician or other licensed clinical practice
• Medication safety and pharmacy workflows
• Medical record review and synthesis
• Healthcare compliance and regulatory requirements
• Clinical quality assurance and evaluation
Experience working with healthcare records, payer policies, clinical guidelines, coding standards, or structured healthcare data is highly valuable.
Candidates should demonstrate the ability to independently analyze complex healthcare scenarios, apply professional judgment, document findings clearly, and distinguish clinically appropriate from inappropriate outputs.
Priority Healthcare Areas
The project may involve evaluation and dataset development across healthcare workflows including:
• Payer Benefit Determination
• Prior Authorization Review
• Prior Authorization and Appeals Preparation
• Medical Record Synthesis
• Inpatient Discharge Summary
• Medication Safety Review
• Clinical Shift Handoff
• Patient Care Triage
• In-Basket Message Drafting
• Outpatient Pre-Visit Preparation
• CPT/HCPCS and E/M Coding
• Claims Denial Appeal Preparation
• Specialty Referral Intake and Triage
Relevant knowledge of standards, systems, and resources such as CMS coverage policies, NCD/LCD guidelines, ICD-10-CM, CPT/HCPCS, NPI/NPPES, FHIR/EHR data, RxNorm, PubMed, and clinical documentation standards may be applicable depending on the assigned workstream.
Education / Expertise
Candidates with educational backgrounds in one or more of the following areas are encouraged to apply:
• Medicine
• Nursing
• Pharmacy
• Health Information Management
• Clinical Documentation Improvement
• Medical Coding
• Healthcare Administration
• Public Health
• Allied Health
• Health Sciences
• Other relevant healthcare disciplines
Equivalent professional experience and demonstrated subject matter expertise may also be considered.
Certifications
Relevant professional certifications or licenses may be considered depending on the assigned workstream, including:
• Registered Nurse (RN)
• Licensed Practical/Vocational Nurse (LPN/LVN)
• Physician or Medical License
• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
• Certified Clinical Documentation Specialist (CCDS)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Certified Inpatient Coder (CIC)
• Other relevant healthcare certifications
Job Details
Type: Independent Contractor
Market: Philippines
Location: Remote
Scope: Healthcare domain quality, evaluation, and dataset development
Start Date: Project-based
Openings: Limited
Schedule: Project-dependent
Important Notes
• Strong healthcare domain expertise is required.
• Work may involve reviewing sensitive or clinically oriented healthcare scenarios.
• Contributors must demonstrate a high level of accuracy and professional judgment.
• Evaluation materials and datasets must be developed from professional healthcare knowledge and experience.
• Project materials must be handled confidentially and in accordance with applicable project requirements.
• Assigned workstreams may vary depending on professional background and project priorities.
• Some workstreams may require familiarity with healthcare coding, payer operations, clinical documentation, or regulatory standards.
• Consistent quality and adherence to project guidelines are essential.
Work Arrangement
Location: Remote
Work Type: Independent Contractor
Schedule: Project-dependent
Scope: Philippines
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 ensure your application clearly reflects your healthcare specialization, professional experience, certifications, and relevant domain expertise.
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
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