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.