Philippine Registered Nurse with 10+ years of experience in healthcare operations, clinical quality auditing, and prior authorizations within the U.S. healthcare system. I have a strong background in medical record review, health information coding, quality assurance, and insurance verification, with proven ability to support providers and improve clinical workflow efficiency.
I spent nine years with Optum Global Solutions, where I developed expertise in clinical documentation review, quality auditing, and identifying trends in healthcare processes to support compliance and operational improvements. My experience includes working with electronic health records (EHR), maintaining data accuracy, and ensuring adherence to healthcare quality standards.
I currently work with direct U.S. clients as a freelance healthcare professional, supporting pain management and gastroenterology clinics. My responsibilities include managing prior authorizations across 40+ insurance providers, including commercial insurance, lien cases, and workers’ compensation. I am experienced in submitting authorization requests, coordinating with insurance companies, tracking approvals, and resolving authorization-related issues to avoid delays in patient care.
I am also a Certified Occupational Health Nurse with knowledge in workplace health surveillance, occupational risk assessment, and employee health programs.
Key Skills & Expertise:
• Prior Authorizations (40+ Insurance Providers)
• Utilization Review & Medical Record Review
• Clinical Quality Auditing
• Insurance Verification & Eligibility
• Workers’ Compensation & Lien Cases
• Pain Management & Gastroenterology Support
• EHR / EMR Systems
• Healthcare Documentation & Compliance
• Medical Virtual Assistance
• Clinical Workflow & Operations Support
I am open to remote opportunities in roles such as Prior Authorization Specialist, Utilization Review Nurse, Clinical Quality Auditor, Medical Virtual Assistant, or Healthcare Operations Support.
Feel free to connect if you are looking for a reliable healthcare professional with strong clinical knowledge and administrative expertise.
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