Prior Authorization/Utilization Review Nurse
HCCA Health ConnectionsShearwater Health
Jan 2014 - Jan 2017 (3 years 1 month)
• Performs both inbound & outbound calls for data entry and verification, prior authorization process, utilization review and billing process for US health insurance claims and reimbursements.
• Acts as a personnel of inquiry with worker's compensation benefits & inquiries.
• Follow protocols to every state of the United States of America (Mandated or Non-Mandated).
• Process appeals for denied claims and communicates to healthcare provider, facilities and adjuster throughout the whole process.