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Remote | Independent Contractor | India

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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.

We are seeking experienced healthcare professionals in India to support a specialized project with : Prior Authorization Review, Prior Authorization & Appeals Preparation, and Medical Record Synthesis.

Depending on your professional background, you may be considered for , , assignments.

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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 , , .

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• 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.

• 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.

• Peer-to-peer review experience.

• CPUR, ACM, or equivalent UM certification.

• Experience with clinical content authoring, data annotation, or evaluation projects.

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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.

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• 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.

• 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.

• 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.

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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.

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• 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.

• 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.

• RHIA or RHIT certification.

• CDIP or CCDS certification.

• Familiarity with HEDIS/MIPS quality measures.

• Experience with clinical data annotation, content authoring, or evaluation projects.

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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.

• : Independent Contractor

• : India

• : Remote

• : Paid hourly

• : Based on project requirements

• : Project-based and subject to client demand

• 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.

• : Remote

• : Independent Contractor

• : Project-dependent / Flexible

• : India

Actual earnings may vary based on task availability, productivity, quality performance, project requirements, certifications, domain expertise, and business needs.

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.

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.

Clinical Review & Medical Documentation Specialist