Registered Nurse |Prior Authorization | Medical Virtual

I am a Registered Nurse (PNLE passer) with solid experience as a Medical Virtual Assistant and Utilization Management Reviewer RN in a multispecialty surgical and healthcare setting. I specialize in insurance verification, benefits checking, prior authorization processing, and utilization review for outpatient and inpatient services.

I have handled high-volume surgical authorizations including breast, reconstructive, and cosmetic procedures, ensuring accurate clinical documentation, timely submissions, and proper coordination with providers, surgery centers, and insurance companies. I am experienced in managing denials, appeals, and follow-ups to secure approvals efficiently.

I am proficient in EMR/EHR systems such as Epic, AthenaOne, OncoEMR, and Symplast, and familiar with insurance portals including Availity, Carelon, UHC, Aetna, Cigna, Humana, Tricare, and others. I am confident in handling end-to-end authorization workflows and maintaining accurate medical records.

I am detail-oriented, organized, and able to work independently in fast-paced environments while ensuring HIPAA compliance, accuracy, and strong communication with healthcare teams.

Core Skills:

Insurance Verification | Prior Authorization | Utilization Management | Denials & Appeals | CPT/ICD-10 Review | Provider Coordination | EMR Documentation | HIPAA Compliance