Registered Nurse and Clinical Services Specialist with experience in prior authorization, insurance verification, and clinical review. Skilled in evaluating medical records, submitting payer requirements, and securing approvals for surgical, medical, and specialty procedures. Proficient in Epic EHR and insurance portals, with strong accuracy, efficiency, and remote case management experience.
CLINICAL AND TECHNICAL SKILLS
• Prior Authorization & Utilization Review
• Insurance Verification & Benefits Eligibility
• Clinical Documentation Review & Medical Records Analysis
• Epic EHR (Chart Review & Workflow Management)
• Payer Portal Submission & Case Processing
• Multispecialty Case Handling (Musculoskeletal, Oncology, Anesthesiology, Surgical, Medical)
• Provider & Insurance Coordination
• Remote Healthcare Operations
