Dena Robinson
McDonough,GA
Summary
Experienced Registered Nurse with 10+ years of experience in outpatient authorizations, hospital, and primary/specialty care settings. Expertise in medical necessity review, payer authorization processes, and interpretation of Medicare and Medicaid guidelines. Skilled in medical record analysis, denial resolution, and collaborating with coding, utilization review, and revenue cycle teams to support accurate documentation and reimbursement. Known for strong organization, attention to detail, and managing multiple priorities in fast-paced healthcare environments.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Infusion Pre-Authorization Nurse Part-time
Piedmont Hospital
Atlanta, GA
02.2022 - Current
- Reviewed outpatient service requests to determine medical necessity and payer authorization requirements in accordance with Medicare, Medicaid, and commercial payer guidelines.
- Analyzed clinical documentation, physician orders, and treatment plans to ensure services met utilization review and reimbursement criteria.
- Collaborated with revenue cycle, pharmacists, and physician offices to resolve authorization issues and support accurate claim submission. Managed a high volume of concurrent cases, prioritizing tasks based on urgency while maintaining attention to detail throughout the pre-authorization process.
- Assisted in the review and resolution of payer denials related to medical necessity, coding discrepancies, and authorization requirements.
- Conducted detailed medical record reviews to extract relevant clinical information supporting appeals and reconsideration requests.
- Prepared appeal documentation and clinical summaries for denied cases submitted to Medicare, Medicaid, and contracted payers.
- Collaborated with pharmacists and physicians to communicate payer formulary requirements, recommending insurance-preferred medications or biosimilar alternatives and coordinating necessary medication or drug code adjustments to ensure coverage approval.
Telephone Triage Registered Nurse PRN
Piedmont Healthcare
Atlanta, GA
08.2020 - 01.2022
- Obtained case history and gathered triage information to determine need to for COVID-19 testing
- Scheduled testing appointments for patients
- Counseled patients via telephone according to established workplace guidelines and protocols regarding COVID-19
- Obtained information to determine if Return to Work clearance was appropriate
Triage Nurse
Augusta University Digestive Health Center
Augusta, GA
09.2019 - 08.2020
- Scheduled appointments for patients not requiring emergency services but needing examination from provider and consulting directly with over 20 providers as needed in clinic setting.
- Relayed triage information and facilitated communication between provider and patient concerning patient disposition.
- Counseled patients via telephone according to established guidelines and protocols, advising on provider-established plans of care.
- Processed medication prior authorizations for specialty therapies by reviewing clinical documentation, submitting requests to insurance providers, and coordinating with prescribers to ensure compliance with payer guidelines; initiated and managed denial responses and appeal requests by compiling supporting clinical information to facilitate authorization approval and continuity of patient care.
Registered Nurse, Med/ Surgical Float Pool, PRN
Augusta University
Augusta, GA
10.2014 - 09.2019
- Delivered outstanding care to patients with various diagnoses and managed care from treatment initiation through to completion on heme/oncology, med-surgical and telemetry floors.
- Accurately documented all elements of nursing assessment, including treatment, medications and IVs administered, discharge instructions and follow-up care.
- Managed patients recovering from medical or surgical procedures, including facilitating wound care, ostomy care, pressure ulcer prevention and pain management.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
Education
Bachelor of Science - Nursing
Georgia Southern University
Statesboro, GA05-2008
Skills
- Triaging
- Teamwork
- Time-management
- Communication
- Organization
- Empathy
- EPIC EMR
- Prior authorization
- Utilization review
Certification
BLS
Compact GA RN License
Additional Information
Professional References
Shalonda Sholes- Charge Nurse Piedmont Hospital
Contact- shalondasholes@gmail.com 404-213-4730
Daphna Lassiter- Charge Nurse Piedmont Hospital
Contact- daphna.lassiter@piedmont.org 229-834-8194
Cynthia Harris- Clinical Nurse Manager
Contact - cynthia.harris@piedmont.org 678-282-4726
Timeline
Infusion Pre-Authorization Nurse Part-time
Piedmont Hospital
02.2022 - Current
Telephone Triage Registered Nurse PRN
Piedmont Healthcare
08.2020 - 01.2022
Triage Nurse
Augusta University Digestive Health Center
09.2019 - 08.2020
Registered Nurse, Med/ Surgical Float Pool, PRN
Augusta University
10.2014 - 09.2019
Bachelor of Science - Nursing
Georgia Southern University