HIPAA-trained US Registered Nurse with strong clinical and administrative experience and a Pre-Service and Utilization Review Nurse. Demonstrated expertise in reviewing medical records, assessing medical necessity, and coordinating with providers offices regarding insurance policies, benefits and prior authorization requirements. Possesses in- depth knowledge of medical terminology, healthcare compliance standards, and payer guidelines. Experienced in healthcare administrative and BPO settings, managing inbound and outbound communications, maintaining accurate documentation within EHR systems, and supporting telehealth and care coordination workflows. Highly organized, detail-oriented, and effective in collaborating with clinical and administrative teams to ensure timely, compliant, and efficient healthcare operations. Comfortable working US business hours with a reliable home office setup.
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