Hello! I’m -----------, a Registered Nurse (USRN and Philippine RN) with over 10 years of professional experience in healthcare administration, insurance processing, and quality assurance for U.S.-based healthcare organizations.Until recently, I worked remotely as a Quality Assurance RN and Payroll Specialist for a U.S. home health agency, where I reviewed clinical documentation, verified visit accuracy, and managed payroll using ADP and EMR systems. I helped streamline processes, ensured compliance with CMS standards, and supported timely and accurate staff payments.Before that, I served as a Utilization Review Nurse for Cigna (via Accenture), handling pre-service and post-service reviews, prior authorizations, denials, and appeals using TruCare, eviCore, and Milliman Care Guidelines. I also have solid experience in medical billing and insurance verification, having worked for a U.S.-based DME supplier managing Medicare Part B and Medicaid claims.I’m highly organized, detail-oriented, and reliable, with excellent English communication skills and a strong ability to adapt to new systems quickly. I value integrity, teamwork, and professionalism — and I’m excited to bring my expertise to a company that values quality and growth.
