Clinical Review & Medical Documentation Specialist (INDIA)

HIRING: CLINICAL REVIEW & MEDICAL DOCUMENTATION SPECIALIST
Remote - Independent Contractor | INDIA

Agents Only Technologies Inc. is seeking experienced healthcare professionals for a specialized project covering prior authorization, utilization management, appeals, clinical documentation, and medical record synthesis.

Candidates may be considered for Tier 1, Tier 2, or Tier 3 based on their expertise.

TIER 1 – PRIOR AUTHORIZATION & UTILIZATION REVIEW
• Develop and evaluate prior-authorization scenarios
• Make Approve / Deny / Request More Information recommendations
• Apply CMS NCD/LCD policies and medical-necessity standards
• Work across multiple clinical specialties

Required:
• Active RN license or MD/DO qualification
• 3+ years in UM, prior authorization, case management, clinical review, or payer-side medical review
• Knowledge of CMS NCD/LCD and medical-necessity standards
• Strong clinical reasoning and documentation skills

Preferred:
• Peer-to-peer review
• CPUR/ACM or equivalent UM certification
• Healthcare content/evaluation experience

TIER 2 – PRIOR AUTHORIZATION & APPEALS
• Review charts and evidence for medical necessity
• Develop prior-authorization evidence packets
• Draft physician-level appeal documentation
• Research and cite peer-reviewed/PubMed literature

Required:
• RN, MD/DO, or relevant clinical documentation qualification
• 3+ years in prior authorization, utilization review, clinical documentation, or denials/appeals
• Clinical documentation review experience
• Strong evidence-based medical writing skills

Preferred:
• Payer appeals experience
• Denials & appeals experience
• Evidence-research experience

TIER 3 – MEDICAL RECORD SYNTHESIS
• Review complex multi-encounter medical records
• Create chronological clinical summaries
• Identify duplicate/redundant testing
• Maintain source traceability
• Work with C-CDA XML and/or FHIR

Required:
• HIM, CDI, or related background
• 3+ years of relevant experience
• Medical record review experience
• Strong medical summarization and structured-writing skills

Preferred:
• RHIA / RHIT
• CDIP / CCDS
• HEDIS/MIPS
• Healthcare data or content experience

RELEVANT BACKGROUNDS
Nursing | Medicine | HIM | CDI | Clinical Informatics | Utilization Management | Medical Review | Healthcare Administration

JOB DETAILS
Type: Independent Contractor
Location: Remote
Market: India
Compensation: Paid hourly
Schedule: Project-dependent / Flexible

Please ensure your profile accurately reflects your experience and certifications.
Only shortlisted candidates will be contacted.