Clinical Review & Documentation Specialist

About the Role Agents Only Technologies is seeking experienced U.S. healthcare professionals to assist with clinical documentation review, healthcare content development, and quality evaluation. Applicants will be matched to **one of three specialization tiers** based on licensure and professional background: * **Tier 1: Utilization Review \& Medical Necessity**Review clinical scenarios, apply CMS coverage guidelines (NCDs/LCDs), and establish standardized coverage recommendations across medical specialties. * **Tier 2: Appeals \& Clinical Evidence**Review denied claims, compile clinical evidence packets, search peer\-reviewed medical literature, and draft formal physician\-level appeal documentation. * **Tier 3: Clinical Documentation \& Chart Synthesis**Organize multi\-visit medical records into chronological summaries, review structured EHR data (C\-CDA / FHIR), and identify documentation redundancies. QualificationsTiers 1 \& 2 (Utilization \& Appeals): * **Licensure:** Active U.S. RN, MD, or DO license. * **Experience:** 3\+ years in Utilization Management, Prior Authorization, Case Management, or Denials/Appeals. * **Expertise:** Direct experience with U.S. payer workflows, CMS coverage rules, and medical necessity criteria. * **Skills:** Strong medical writing and literature research capabilities. Tier 3 (Documentation Synthesis): * **Background:** Health Information Management (HIM), Clinical Documentation Improvement (CDI), or Healthcare Informatics. * **Experience:** 3\+ years reviewing multi\-encounter charts and complex health records. * **Technical Knowledge:** Familiarity with C\-CDA XML or FHIR data standards. Preferred Qualifications * Active certifications: **CPUR, ACM, RHIA, RHIT, CDIP, or CCDS**. * Peer\-to\-peer review experience or direct background drafting payer appeals. * Experience in clinical content writing, quality auditing, or healthcare documentation projects. How to Apply When submitting your application, **please indicate your primary tier of interest:** * **Tier 1:** Utilization Review \& Medical Necessity * **Tier 2:** Appeals \& Clinical Evidence * **Tier 3:** Clinical Documentation \& Chart Synthesis *Ensure your resume reflects active credentials, state licensures, and relevant U.S. healthcare experience.* Pay: $35\.70 \- $42\.99 per hour Expected hours: 20\.0 per week Benefits: * Flexible schedule Work Location: Remote