Pauline J Trimble

• Researched and resolved routine and complex issues.
• Processed eligibility and benefits verification and authorization requests.
• Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
• Followed up on denials, late payments, extensions and other special circumstances.

• Communicated with customers to identify and resolve outstanding payments.
• Reconciled accounts receivable ledger to verify payments and resolve variances.
• Prepared billing statements and invoices for customer purchases and recorded transaction date, price and fees to support accuracy.
• Processed bill reminders and consulted with third-party collection agency to resolve past-due customer accounts.

• Submitted electronic/paper claims documentation for timely filing.
• Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
• Managed large volume of medical claims on daily basis.
• Paid or denied medical claims based upon established claims processing criteria.
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• Communicated with insurance providers to resolve denied claims and resubmitted.
• Collected payments and applied to patient accounts.
• Filed and updated patient information and medical records.
• Posted payments and collections on regular basis.

Processed member reimbursement claims and resolve payment issues

Worked closely with Member Services Department

Provided back-up for Provider Call Center

Processed claims for Second Submissions Team

Researched and resolved on line pends and out of country claims.

Exceeded production and quality goals each month.

• Evaluated accuracy and quality of data entered into agency management system.
• Followed up with customers on unresolved issues.
• Collaborated with claims department and industry anti-fraud organizations to resolve claims.
• Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.