Mahagany Nelson
Princeton
Summary
Highly skilled Prior Authorization Specialist with extensive experience in processing prior authorizations, insurance verification, ICD-10/CPT coding, payer communication, and denial management across a variety of healthcare settings. Adept at handling complex payer requirements, navigating Medicare, Medicaid, and commercial insurance policies, and resolving denials through effective appeals processes. Proficient in Microsoft Excel for tracking authorizations, maintaining detailed case logs, and supporting workflow improvements. Consistently ensures compliance with HIPAA and regulatory guidelines while enhancing operational efficiency and revenue recovery. Demonstrates expertise in collaborating with clinical teams to streamline workflows, improve patient satisfaction, and ensure accurate reimbursement.
U.S citizen - Authorized for all U.S employers
Overview
4
4
years of professional experience
1
1
Certification
Work History
Sales Coordinator
Fivebelow
07.2025 - Current
- Worked closely with the sales team to prioritize tasks, set goals, and allocate resources efficiently; resulting in increased productivity and revenue.
- Maintained accurate records of all sales activities, including contracts, proposals, quotes, follow-ups, and customer communications.
- Increased sales revenue by establishing strong relationships with clients and identifying new business opportunities.
- Streamlined sales processes for improved efficiency and customer satisfaction.
Legal Intake specialist
National Debt Relief
07.2024 - 02.2025
- Interviewing prospective clients by phone and email to become familiar with their cases
- Conducting basic research to investigate whether prospective clients’ claims have merit
- Evaluating prospective clients’ claims to determine whether they’re in line with the areas of practice and experience of the firm
- Scheduling initial consultation appointments with attorneys for promising potential candidates
- Onboarding new clients by filling out necessary paperwork and putting together initial case files
- Entering client information into computer systems
- Networking with law firms in other areas of specialty to grow referrals
- Performing administrative support tasks as assigned
- Required 35-40pw
- (Took a brief career break due to relocation)
- Elevated the reputation of the firm by consistently providing prompt, courteous service to prospective clients during their initial consultations.
- Maintained up-to-date knowledge of legal trends and developments, enabling accurate assessment of potential cases during initial consultations.
Senior Prior Authorization Coordinator
RemX, McKesson Specialty
10.2023 - 01.2024
- Handled authorization submissions and follow-ups for all insurance payers, including Medicare, Medicaid, HMOs, and PPOs.
- Answered incoming calls through the toll-free Pre-Authorization Support ACD and provided appropriate case handling and documentation.
- Performed initial benefit verification and pre-surgical authorization for new cases by coordinating closely with insurance payers.
- Performed payer research, payment processing, and maintained detailed tracking of authorization statuses using Microsoft Excel.
- Documented case statuses, actions taken, and outcomes in the Pre-Authorization Support system as needed.
- Communicated and built strong relationships with healthcare provider (HCP) offices and sales representatives to manage case inquiries and missing information.
- Notified appropriate internal departments regarding complaints, adverse event notifications, and other necessary updates.
- Utilized customer service skills to engage with patients, coordinate with sales representatives, and work collaboratively within a call center environment to expedite case processing.
- Updated patient insurance and demographic information accurately and efficiently.
- Managed multiple authorization requests simultaneously while maintaining attention to detail and timely follow-up.
- Followed up on post-claim denials and assisted with denial resolution processes.
- Applied knowledge of medical terminology, clinical policies, insurance carrier guidelines, ICD-10 and CPT codes, and Medicare/Medicaid approval processes.
- Ensured compliance with state and federal regulatory guidelines for coverage and prior authorization.
- Submitted clinical documentation for authorization of high-cost pharmaceuticals, radio-pharmaceuticals, and off-label chemotherapy regimens.
- Collaborated with the Prior Authorization Manager and team lead to review and appeal rejected claims within required timelines.
- Supported the Revenue Integrity Specialist in resolving prior authorization denials.
- Ensured timely resolution of all assigned authorizations within established timeframes.
- Researched, followed up, and resolved open or pending authorizations promptly.
- Contacted payers to obtain the status of outstanding or pending authorization requests.
- Met daily requirements of 35-45 authorization submissions and follow-ups.
- Verified patient insurance eligibility and benefits through internet resources or by direct communication with insurance carriers.
- Provided accurate information regarding procedure codes and diagnostic codes to secure proper referrals and authorizations for inpatient and outpatient procedures.
- Communicated and coordinated with interdepartmental and interoffice teams to ensure complete and accurate referral and authorization information.
Medical Data Entry Specialist
LaSalle Network
05.2023 - 07.2023
- Processed prior authorization requests by reviewing patient information and medical documentation to determine eligibility for coverage.
- Conducted insurance verification across multiple payers, including Medicare, to ensure accurate benefits assessment.
- Handled denial appeals related to prior authorizations, preparing supporting paperwork and communicating with insurance carriers to overturn denials.
- Utilized ICD and CPT coding to accurately document services for prior authorization submissions and claims processing.
- Performed payer research, payment processing, and maintained detailed tracking of authorization statuses using Microsoft Excel.
- Collaborated with clinical and administrative teams to streamline workflows and ensure timely submission of authorization requests.
- Ensured compliance with federal and state regulations in medical collections, preventing potential legal issues
- Boosted revenue recovery by diligently following up on overdue accounts.
- Enhanced patient satisfaction by swiftly resolving medical billing disputes.
- Collaborated with clinical teams to verify services, ensuring precise coding and billing.
- Minimized billing errors through a robust quality control system.
- Performed regular audits of patient accounts to identify and rectify discrepancies.
- Analyzed account receivables to spot trends and proactively mitigate issues.
- Effectively managed a high-volume caseload while maintaining meticulous attention to detail in billing adjustments.
Senior Case Manager
Linebarger Goggan Blair Sampson
12.2021 - 02.2022
- Achieved high levels of client satisfaction through timely resolution of billing disputes or other account-related concerns.
- Completed routine and complex account updates to resolve problems.
- Enhanced client satisfaction by promptly resolving account issues and providing exceptional customer service.
- Resolved complex billing and payment issues for balanced, accurate accounts.
- Managed multiple accounts simultaneously, demonstrating exceptional organizational skills and attention to detail.
- Set up new customer accounts and updated existing profiles with latest information.
- Adhered to standards of quality and service as well as all compliance requirements.
- Maintained strong relationships with clients through regular communication and proactive problem-solving efforts.
- Reviewed account activity to assess financial status and evaluate discrepancies.
- Developed customized financial solutions for clients, addressing their unique needs and concerns.
- Ensured compliance with industry regulations by diligently reviewing account documentation and transactions.
Education
High School Diploma -
Lewisville High School
Lewisville, TX05-2020
Bachelors’ Science Accounting - Information Health Technology
Southern New Hampshire University
02.2028
Skills
- Prior Authorization Processing
- Customer Relationship Management (CRM) Software
- Medical Terminology
- ICD-9/10
- CPT
- Pay Revenue Cycle
- Insurance Verification
- Accounts Receivable
- Appeals/Denials
- Explanation of Benefits (EOB)
- Problem-Solving
- Customer Service
- Microsoft Excel
- HIPAA Compliance
- Documentation
- Microsoft Word
- Microsoft PowerPoint
- Insurance Denials
- Medical Billing
- Medicare Secondary Payer Recovery Portal (MSPRP)
- Claims Tracking
- Data Entry
- Insurance Portals
- Prior Authorization Appeals
- Communication
- Workflow Improvement
- Case Management
- Reimbursement Processes
- Payer Relations
- Benefit Investigation
- Medical Records Retrieval
- Recordkeeping
- Issue resolution
- CRM software proficiency
- Account management
Certification
ACE Training Institute, Houston, TX-10101 Harwin Dr Ste 110, Houston, TX 77036
- CNA - Certified Nurse Assistant-Certificate
Languages
English
Native or Bilingual
Timeline
Sales Coordinator
Fivebelow
07.2025 - Current
Legal Intake specialist
National Debt Relief
07.2024 - 02.2025
Senior Prior Authorization Coordinator
RemX, McKesson Specialty
10.2023 - 01.2024
Medical Data Entry Specialist
LaSalle Network
05.2023 - 07.2023
Senior Case Manager
Linebarger Goggan Blair Sampson
12.2021 - 02.2022
Bachelors’ Science Accounting - Information Health Technology
Southern New Hampshire University
High School Diploma -
Lewisville High School
Supplier Notes
- Mahagany has 2+ years of experience in processing prior authorizations, insurance verification, ICD-10/CPT coding, payer communication, and denial management across a variety of healthcare settings.
- Extensive experience conducting insurance verification across multiple payers, including Medicare, to ensure accurate benefits assessment.
- Well-versed in utilizing ICD and CPT coding to accurately document services for prior authorization submissions and claims processing.
- Experienced in handling authorization submissions and follow-ups for all insurance payers, including Medicare, Medicaid, HMOs, and PPOs.
- Strong attention to detail with solid computer skills, including MS Office and web browsing.
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