Kevin Hairston Jr.
Westbury,NY
Summary
Managerial professional with proven record of streamlining processes and leading high-performing teams. Known for strong analytical skills and commitment to achieving results. Teams rely on collaborative leadership and adaptability to changing needs.
Overview
13
13
years of professional experience
Work History
Prior Authorization Manager
Optum
03.2021 - Current
- Managed prior authorization requests for medical procedures and medications.
- Reviewed and processed prior authorization requests from healthcare providers.
- Maintained accurate documentation of prior authorization cases and outcomes.
- Collaborated with insurance companies to ensure timely approval of prior authorizations.
- Resolved issues and inquiries related to prior authorizations promptly.
- Supported healthcare providers in navigating the prior authorization process.
- Trained new team members on prior authorization procedures and protocols.
- Implemented strategies to streamline the prior authorization process and improve efficiency.
Authorization Specialist
MVP Vascular Diagnostics
11.2020 - 03.2021
- Reviewed and verified patient demographic and insurance information for accuracy.
- Assisted in resolving insurance denials and appeals to ensure timely reimbursement.
- Handled customer inquiries and concerns regarding insurance coverage and billing.
- Performed prior authorization requests for medical procedures and medications.
- Managed and processed patient insurance claims for a medical billing company.
Prior Authorization Manager
Ophthalmic Consultants of Long Island
06.2017 - 11.2020
- Managed prior authorization requests for medical procedures and medications.
- Reviewed and processed prior authorization requests from healthcare providers.
- Maintained accurate documentation of prior authorization cases and outcomes.
- Collaborated with insurance companies to ensure timely approval of prior authorizations.
- Resolved issues and inquiries related to prior authorizations in a timely manner.
- Supported healthcare providers in navigating the prior authorization process.
- Trained new team members on prior authorization procedures and protocols.
- Implemented strategies to streamline the prior authorization process and improve efficiency.
Patient Care Coordinator
Ophthalmic Consultants of Long Island
01.2013 - 06.2017
- Maintained a safe and therapeutic environment for patients and their caregivers.
- Educated patients and their families on treatment options and healthcare resources.
- Documented patient assessments, interventions, and outcomes in a timely and accurate manner.
- Monitored and evaluated the effectiveness of care plans and made adjustments as needed.
- Advocated for patients' needs and ensured they received appropriate medical services.
- Ensured continuity of care by communicating effectively with healthcare providers and patients.
- Collaborated with interdisciplinary team members to develop and implement patient care plans.
- Managed a caseload of patients and provided high-quality care coordination services.
Education
Associate of Arts - Psychology
Nassau Community College
Garden City, NY01.2023
Bachelor's - Fashion Merchandising
Southern New Hampshire University
01.2022
Phlebotomy Certification - undefined
Franklin Career Institute
Franklin Square, NY01.2004
Diploma - undefined
Manhasset High School
01.2000
Skills
- Proficient in Microsoft Office
- ICD-10 coding expertise
- CPT coding expertise
- Quality assurance
- Patient appointment coordination
- Accounts receivable management
- Hands-on laboratory experience
- Proficient in medical billing processes
- Management oversight skills
- Experienced in medical coding
MILITARY SERVICES
- Branch: United States Navy
- September 2001
- Honorable Discharge
- Commendations:
- Decorated Soldier “Battle E Ribbon”
- Basic Damage Control certified, Damage Control communications certified, Fire Fighting certified, Sound & Security, Basic First Aid certified, Booting Qualified, Seamanship Specialist, Infantry & Gun crew, Honorable Discharge
Timeline
Prior Authorization Manager
Optum
03.2021 - Current
Authorization Specialist
MVP Vascular Diagnostics
11.2020 - 03.2021
Prior Authorization Manager
Ophthalmic Consultants of Long Island
06.2017 - 11.2020
Patient Care Coordinator
Ophthalmic Consultants of Long Island
01.2013 - 06.2017
Bachelor's - Fashion Merchandising
Southern New Hampshire University
Phlebotomy Certification - undefined
Franklin Career Institute
Diploma - undefined
Manhasset High School
Associate of Arts - Psychology
Nassau Community College