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maria faraon

@mariafaraon

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I review outpatient authorizations and appeals using clinical criteria, medical records, and payer requirements.

Philippines

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What I'm looking for

I'm looking for a clinical review or prior authorization role where I can apply evidence-based criteria, medical-necessity review, and accurate documentation to support timely coverage decisions.

I've supported U.S. healthcare operations for more than 10 years, reviewing medical records, physician documentation, and diagnostic reports for outpatient prior authorization decisions.

At AGS Health, I handle prior authorization reviews, denials, and appeals, using Epic and applying CMS, InterQual®, and MCG guidelines to assess medical necessity.

Previously at Sagility, I performed outpatient utilization reviews and DME medical-necessity reviews, identified documentation gaps, and collaborated with providers to obtain required clinical records.

I'm an active Registered Nurse in Illinois and the Philippines, focused on accurate clinical rationales, compliant documentation, and timely authorization decisions.

Experience

Work history, roles, and key accomplishments

Prior Authorization Nurse | Denials & Appeals Specialist

AGS Health

Jan 2024 - Apr 2026 (2 years 3 months)

Reviewed physician documentation and diagnostic reports for prior authorization requests, applied CMS, InterQual, and MCG guidelines, and prepared appeal recommendations for denied claims.

Epic InterQual Prior Authorizations Clinical Documentation Denials Management Appeals