Summary
Overview
Work History
Education
Skills
Timeline
Generic

Gerald Hazley Jr

Fort Worth,TX

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

19
19
years of professional experience

Work History

Reimbursement Pre-Authorization Specialist

Bostin Scientific / Talent
04.2024 - Current
  • Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
  • Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.

Benefits Verification Specialist

Aston Carter / Amgen
03.2023 - 04.2024
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.

Insurance Verification Specialist

North Central Surgical Center Hospital
10.2022 - 03.2023
  • Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.
  • Complied with HIPAA guidelines and regulations for confidential patient data.

Benefits Verification Specialist

AmerisourceBergen/ CVS Caremark
06.2021 - 10.2022
  • Complete benefits verification for medical and pharmacy plans. Commercial and Medicare/ Medicaid plans.
  • Initiating prior authorizations and appeals via form, verbally, and electronically.
  • Follow ups to patients, MDO's and insurance plans.
  • Check eligibility for medications, injections, surgeries, injection procedures, and radiology

Benefits Investigator

CARDINAL HEALTH
10.2015 - 06.2021
  • Conducted benefits investigations to confirm patient medication covered under their insurance plan.
  • Follow through on all benefit investigation rejections, including prior authorizations and appeals.
  • Make all outbound calls to patients and/or providers to discuss any missing or benefit related information.
  • Coached employees through day-to-day work and complex problems.
  • EOB

ESCALATION TEAM LEADER

JCPENNEY
01.2010 - 09.2015
  • Provided direct support to customers with issues regarding billing, shipping and ordering while maintaining excellent customer service
  • Conducted training and mentored team members to promote productivity, accuracy and commitment to friendly service.

Underwriter

JP Morgan Chase
01.2006 - 01.2010
  • Reviewed applications for insurance coverage and reports from loss control specialists to determine risks.
  • Evaluated debt ratio, loan-to-value ratios, credit scores property valuations and various other factors when making underwriting decisions.
  • Analyzed credit, income, compliance, title documents, and appraisals during underwriting process.

Education

Associates Degree - Pharmacy Technician CVS Pharmacy Retail Pharmacy Externship

Kaplan College
Milwaukee, WI
06.2009

High School Diploma -

Shorewood High School
Milwaukee, WI
06.2004

Skills

  • Open Enrollment
  • Patient Assistance Program
  • Program Requirements
  • Quality Assurance
  • Benefits Explanations
  • Customer Inquiries
  • Customer Care
  • Prior Authorizations
  • Insurance Terminology

Timeline

Reimbursement Pre-Authorization Specialist

Bostin Scientific / Talent
04.2024 - Current

Benefits Verification Specialist

Aston Carter / Amgen
03.2023 - 04.2024

Insurance Verification Specialist

North Central Surgical Center Hospital
10.2022 - 03.2023

Benefits Verification Specialist

AmerisourceBergen/ CVS Caremark
06.2021 - 10.2022

Benefits Investigator

CARDINAL HEALTH
10.2015 - 06.2021

ESCALATION TEAM LEADER

JCPENNEY
01.2010 - 09.2015

Underwriter

JP Morgan Chase
01.2006 - 01.2010

Associates Degree - Pharmacy Technician CVS Pharmacy Retail Pharmacy Externship

Kaplan College

High School Diploma -

Shorewood High School

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Gerald Hazley Jr