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Mahagany Nelson

@mahaganynelson

Message

I streamline complex prior authorization workflows across behavioral health, infusion therapy, and pharmacy benefits.

United States

Message

What I'm looking for

I'm looking to continue supporting complex healthcare authorization and pharmacy-benefits workflows, using accurate documentation, payer coordination, benefit investigation, and HIPAA-compliant case management to help patients access medically necessary care.

I've supported prior authorization workflows at Luminaure Health, Optum/UnitedHealthcare, Wipro, McKesson, and MedServ International, helping patients, providers, and facilities navigate benefit verification, claims tracking, and authorization follow-up.

I handle complex behavioral health, ABA, inpatient treatment, infusion therapy, and specialty-medication cases, reviewing documentation, payer requirements, eligibility, and benefits across Medicare, Medicaid, commercial, HMO/PPO, and PBM plans.

I've managed appeals, denials, payer communications, and high-volume case tracking while using ICD-10/CPT knowledge, Excel, payer portals, and accurate HIPAA-compliant documentation to help prevent delays in medically necessary care.

Experience

Work history, roles, and key accomplishments

Current

Prior Authorization Specialist

Current

Luminaure Health

Jul 2026 - Present (2 months)

Support patients, providers, and healthcare facilities with prior authorization intake, insurance questions, benefit verification, claims tracking, and authorization status follow-up in a high-volume remote environment.

Prior Authorizations Insurance Verification Benefit Verification Claims Tracking HIPAA compliance Customer Service Documentation Behavioral Health Applied Behavior Analysis (ABA)Inpatient Treatment Infusion Therapy

Prior Authorization Specialist

Optum / UnitedHealthcare

Dec 2025 - May 2026 (5 months)

Processed high-volume prior authorization and insurance-verification requests while following healthcare, PBM, payer, and documentation guidelines. Supported complex authorization workflows and managed appeals and authorization status updates.

Prior Authorizations Insurance Verification PBMs Payer Guidelines Appeals Provider communication Case Tracking Documentation

Prior Authorization Specialist

Wipro

Mar 2025 - Dec 2025 (9 months)

Reviewed clinical documentation, verified eligibility and benefits, submitted authorization requests, and resolved payer escalations across healthcare services. Maintained detailed authorization records and supported reimbursement accuracy.

Prior Authorizations Clinical Documentation Review Eligibility Verification Benefits Verification ICD 10 CPT Payer Escalation Reimbursement

Legal Intake Specialist

National Debt Relief

Jul 2024 - Feb 2025 (7 months)

Conducted high-volume client intake, case documentation, records management, and remote customer service, strengthening transferable skills in scripted communication, documentation accuracy, confidentiality, and case ownership.

Client intake Case Documentation Records Management Customer Service Confidentiality Case Ownership

Prior Authorization Specialist

LaSalle Network

Dec 2022 - May 2023 (5 months)

Managed authorization requests, insurance verification, appeals, and denial resolution for Medicare and commercial plans. Used ICD-10/CPT coding, Excel tracking tools, payer research, and documentation review to improve claim accuracy.

Prior Authorizations Insurance Verification Appeals Denial Resolution Medicare Commercial Plans ICD 10 CPT Excel Payer Research Documentation Review

Senior Prior Authorization Coordinator

MedServ International

Nov 2022 - Apr 2023 (5 months)

Handled approximately 35–45 daily authorization requests and follow-ups across Medicare, Medicaid, HMO, PPO, and commercial plans. Coordinated with providers, sales representatives, payers, and internal teams to expedite approvals and resolve denials.

Prior Authorizations Medicare Medicaid HMO PPO Commercial Plans Provider coordination Denial Resolution Benefits Investigation Documentation

Senior Case Manager / Prior Authorization Specialist

Linebarger Goggan Blair & Sampson

Dec 2021 - Aug 2022 (8 months)

Managed authorization workflows, appeals, payer communications, and case tracking while coordinating with clinical and operational teams. Maintained organized case documentation and supported timely approvals and accurate reimbursement processing.

Prior Authorizations Appeals Payer Relations Case Tracking Case Management Documentation Reimbursement

Prior Authorization Specialist

McKesson

Aug 2021 - Aug 2022 (1 year)

Supported prior authorization, insurance verification, reimbursement, and denial-management workflows in a high-volume healthcare environment. Assisted with specialty-medication and infusion-related benefit/authorization workflows.