Document Review Specialist jobs

About Agents Only Technologies Inc.

Agents Only Technologies Inc. is a global workforce and operations firm supporting technology, healthcare, 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 healthcare division supports specialized clinical review, medical documentation, utilization management, and complex record synthesis projects requiring strong subject-matter expertise.

Role Overview

We are seeking experienced healthcare professionals (RNs, MDs, HIM, or CDI Specialists) based in India to support specialized clinical documentation, prior authorization, and medical record review projects.

Depending on your professional background and clinical background, responsibilities may span Utilization Management, Appeals & Denials Preparation, or Health Information Management (HIM) Record Synthesis.

Key Responsibilities

1. Utilization Management & Prior Authorization Review

• Review clinical case files and medical necessity requests across multiple specialties (radiology, cardiology, orthopedics, behavioral health, etc.).
• Apply CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) to determine appropriate coverage actions (Approve, Deny, or Request Additional Information).
• Evaluate clinical documentation for completeness and medical necessity compliance.

2. Appeals & Evidence Synthesis

• Review patient charts and construct complete, evidence-based documentation packages supporting medical necessity following a claim denial.
• Draft detailed physician-level appeal arguments citing relevant CMS coverage policies and current peer-reviewed medical literature.
• Evaluate the strength, accuracy, and completeness of complex clinical arguments.

3. Medical Record Synthesis & CDI

• Review and synthesize complex, multi-visit patient charts into clear, chronological clinical summaries.
• Work with structured clinical data formats (such as C-CDA XML and FHIR records) to organize medical history accurately.
• Identify duplicate or redundant testing and diagnostic procedures across multiple patient encounters.
• Apply Clinical Documentation Improvement (CDI) and Health Information Management (HIM) principles to ensure clear source-to-summary traceability.

Qualifications & Requirements

Required

• Clinical Qualification: Active RN license, MD/DO, or formal credentials in Health Information Management (RHIA/RHIT) or Clinical Documentation Improvement (CDIP/CCDS).
• Experience: Minimum 3+ years of professional experience in utilization review, prior authorization, denials/appeals, case management, or HIM/CDI.
• Working knowledge of CMS NCD/LCD coverage standards and medical necessity criteria.
• Strong written communication skills with experience conducting literature searches and medical drafting.
• Proficiency in navigating complex electronic health records (EHR) and structured clinical data (C-CDA, FHIR).

Preferred

• Board certification or professional credentials in Utilization Management (CPUR, ACM) or Health Information (RHIA, RHIT, CDIP, CCDS).
• Experience drafting formal healthcare payer appeal letters.
• Broad clinical experience across multiple medical and surgical specialties.

Work Details

• Employment Type: Independent Contractor
• Location: Remote (India-based candidates)
• Schedule: Flexible / Project-based hours

Equal Opportunity Employer

Agents Only Technologies Inc. is committed to fostering an inclusive, global workforce. We welcome qualified candidates from all backgrounds. Selection is based strictly on professional qualifications, experience, and project requirements.

Pay: From ₹270.00 per hour

Benefits:

• Flexible schedule
• Work from home

Work Location: Remote