USRN (New York) | PHRN | 8+ Years in U.S. Healthcare | Utilization Management | Clinical QA | Home Health QA | Medical Record Review | Prior Authorization | Insurance Verification | Medicare | Remote Healthcare Operations

I’m a USRN and PHRN with 10+ years of experience in US healthcare operations, specializing in utilization review, medical necessity evaluation, insurance workflows, and quality assurance.

I help healthcare companies improve accuracy, reduce claim denials, and maintain strict compliance with payer and regulatory standards.

My background combines clinical nursing expertise with deep operational experience, allowing me to deliver both medical accuracy and process efficiency.

Core Expertise:

Utilization Review & Medical Necessity Determination
Prior Authorization & Pre-certification Processing
Insurance Verification & Benefits Coordination
Medical Records Review (ICD-10, CPT familiarity)
Claims Support & Documentation Accuracy
Quality Assurance & Compliance Auditing
KPI Monitoring & Performance Optimization

Leadership & Impact:

Led healthcare teams to consistently meet KPIs and SLAs
Reduced errors through structured QA and coaching programs
Improved workflow efficiency through process optimization
Ensured compliance with insurance and healthcare standards

What sets me apart:

Unlike general VAs, I bring licensed clinical expertise + healthcare operations experience, allowing me to understand both patient care and backend systems.

I don’t just complete tasks—I help optimize your healthcare operations.