Jerrome Mckely
Hagerstown,MD
Summary
Dynamic Prior Authorization Representative with expertise in medical terminology and patient eligibility verification at CVScaremark. Proven track record in achieving service level goals and enhancing customer satisfaction through effective communication and problem-solving skills. Adept at collaborating with healthcare providers to streamline authorization processes and ensure compliance with HIPAA regulations.
Overview
18
18
years of professional experience
Work History
Prior Authorization Representative
CVScaremark (Remote)
Hagerstown, Maryland
11.2025 - Current
- Processed prior authorization requests for various medications and treatments.
- Reviewed medical records to verify patient eligibility and coverage.
- Collaborated with healthcare providers to obtain necessary documentation.
- Processed prior authorization requests for medications efficiently and accurately.
Pre Authorization Representative
Commonwealth Care Alliance
12.2022 - 09.2025
- Received authorization requests from hospitals, providers, customers, and vendors via multiple channels.
- Achieved service level goals including Grade of Service and Average Handle Time.
- Determined authorization requirements in accordance with company policy and member benefit grid.
- Reviewed customer coverage and benefits to ensure accurate processing.
- Evaluated authorization requests to determine appropriate processes for approvals or referrals.
- Maintained benchmark standards for Turn-Around-Time established by organization.
- Demonstrated professional demeanor, effectively collaborating within teams or working independently.
- Adapted to shifting priorities while maintaining acceptable attendance as per policy.
Patient services
Symetra
Washington, DC
01.2021 - 12.2022
- Photocopied and filed patient documents for reliable recordkeeping.
- Helped team maintain smooth patient flow by planning and implementing successful schedules.
- Treated orthopedic conditions non-operatively based on diagnoses and patient presentations.
- Maintained knowledge of community services and resources available to patients.
- Served diverse patient populations with in-depth knowledge of diverse injuries, surgical services and disease states.
- Assisted registered nursing personnel in care of patients by performing wide-ranging care activities and related non-medical services.
- HIPAA compliance
- Claims processing
- Medical terminology
- Customer service
- Contract
Patient Service Representative
Optimum
Washington, DC
04.2015 - 05.2020
- Answered incoming calls promptly while demonstrating excellent phone etiquette and professionalism.
- Performed patient registration and scheduling in a fast-paced environment with accuracy and efficiency.
- Scheduled appointments and assisted with referrals.
- Verified patient information to ensure accuracy prior to appointment check-in.
- Contract
District Manager
Buffalo Wild Wings
05.2008 - 06.2015
- Maintained strong focus on safety procedures throughout all stores in district.
- Developed and implemented sales strategies to increase overall revenue in district.
- Fostered positive work environment that encouraged teamwork and collaboration among employees.
- Developed managers into successful leaders through training and hands-on support.
- Addressed customer concerns and feedback promptly, implementing resolutions as needed.
- Collaborated with regional management team on achieving company-wide goals.
Skills
- CRM and customer relationship management
- Customer satisfaction and NPS
- Microsoft Excel and Windows applications
- Social media engagement
- Networking and relationship building
- Policy comprehension
- Dispute resolution strategies
- Medical terminology expertise
- HIPAA compliance knowledge
- Authorization evaluation processes
- Patient eligibility verification
- Documentation collaboration skills
- Coverage analysis proficiency
- Effective communication skills
- Problem-solving abilities
- Team collaboration dynamics
- Time management strategies
- Co-payment collection methods
- Coverage determination requests
Timeline
Prior Authorization Representative
CVScaremark (Remote)
11.2025 - Current
Pre Authorization Representative
Commonwealth Care Alliance
12.2022 - 09.2025
Patient services
Symetra
01.2021 - 12.2022
Patient Service Representative
Optimum
04.2015 - 05.2020
District Manager
Buffalo Wild Wings
05.2008 - 06.2015