Open to opportunities

Natalie Jiménez

@nataliejimnez

Message

Experienced pharmacy technician and medical records specialist fluent in English and Spanish.

Puerto Rico

Message

What I'm looking for

I seek a role leveraging prior authorization and EHR expertise in a collaborative, compliance-focused healthcare team with growth opportunities.

I am an experienced pharmacy technician and medical records specialist with hands-on experience in prior authorizations, appeals, and grievances within managed care and pharmacy settings. I have managed EHR documentation, processed information requests, and supported billing and coding to improve claims accuracy.

My background includes direct member services work, prescription processing, and quality control inspection roles where I performed detailed data entry, verification, and quality assurance tasks. I take pride in maintaining HIPAA and Medicare compliance while delivering clear patient and provider communication in both English and Spanish.

I bring reliable attention to detail, strong organizational habits, and a practical understanding of medical terminology and pharmacy operations that help streamline authorization workflows and ensure accurate records management.

Experience

Work history, roles, and key accomplishments

Prior Authorization Specialist

Optum Rx

Oct 2021 - Sep 2025 (3 years 11 months)

Managed prior authorizations, appeals and grievances, collecting and reviewing medical records and EHRs to support accurate claims and appeals processing. Improved documentation quality through thorough data entry and verification to support billing and coding teams.

Prior Authorizations Appeals EHR Medical Records Management Data Entry HIPAA Medical Terminology

Member Services Representative II

Humana / CarePlus Managed Care

Apr 2020 - Aug 2021 (1 year 4 months)

Supported member inquiries on claims, prior authorizations and coverage, performed quality checks on medical records, processed prescriptions and maintained accurate medication records. Educated members on appeal rights, billing, authorizations and enrollment processes.

Member Services Enrollment Customer Service

Quality Control Inspector

Tedeschi

Feb 2013 - Jan 2020 (6 years 11 months)

Performed final inspections of finished products, documented inspection results and maintained measurement equipment to ensure compliance with quality standards. Processed damaged-item reports and updated quality databases to support shipment accuracy.

Data Entry Inventory Control Compliance Reporting