Customer Service Relations
Resume:
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JERROME
MCKELY
PRIOR AUTHORIZATION
REPRESENTATIVE
CONTACT
***********@*****.***
SKILLS
• CRM
• NPS
• Microsoft Excel
• Customer Service
• Social Media
• Relationship Building
• Policy Understanding
• Dispute Resolution
• Windows Microsoft
• Teams
• Customer relations
• Professionalism and courtesy
• Data entry proficiency
• Call management
• Quality assurance
• Customer education
• Fieldwork experience
• Dispute resolution
• Policy interpretation
• Cross-selling products
• Document coordination
• Invoicing procedures
• Claims reviewing
• Obtaining reports
PROFESSIONAL SUMMARY
Bringing expertise in customer relations, data accuracy, and compliance, with experience in resolving account issues and improving team performance. Skilled in utilizing CRM systems and Microsoft Excel, ensuring efficient authorization processes. Strong foundation in policy interpretation, dispute resolution, and customer Service.
December 2022 - September 2025
Pre Authorization Representative
Commonwealth Care Alliance (Ellicott Group)
• Receive authorization requests from hospitals, providers, customers, and vendors via fax, phone, and portal.
• Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate).
• Determine authorization requirements based on company policy, member benefit grid, and provider status.
• Review customer coverage and benefits.
• Review authorization requests and make determinations on correct authorization process (i.e Auto approve, refer to Utilization Management Nurse).
• Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
• Professional demeanor and the ability to work effectively within a team or independently.
• Flexible with the ability to shift priorities when required.
• Maintains regular and acceptable attendance in accordance with Time Away From Work policy.
• Ability to work evening, weekend and holiday shifts to support the UM Department.
• Other duties as requested.
January 2021 - December 2022
Patient services
Symetra (contract), Washington, DC
• 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
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• HIPAA compliance
• Claims processing
• Medical terminology
• Customer service
services.
• Assessed patients' current situations by conducting comprehensive nutritional assessments.
April 2015 - May 2020
Patient Service Representative
Optimum (contract), Washington, DC
• 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.
May 2008 - June 2015
District Manager
Buffalo Wild Wings
• 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.
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