Susan Trimble
Roaring Spring,PA
Summary
Case manager managing high caseloads while maintaining quality of care. Assesses patient needs and recommends appropriate resources and next steps. Coordinating services to support optimal quality of life.
Overview
1
1
Certification
12
12
years of professional experience
Work History
Territory Case Manager
Cardinal Health
Dublin, OH
07.2025 - Current
- Coordinated patient cases through Cardinal Health service programs and referral workflows to enhance patient access and support.
- Assisted patients with enrollment, support, and medication access processes to improve their overall healthcare experience.
- Reviewed eligibility, benefits, and prior authorization requirements for patient access.
- Monitored client progress through regular follow-up contacts.
- Monitored open cases to ensure timely resolution and follow-up. and followed up on missing clinical or insurance information.
- Entered detailed case notes into Cardinal Health case management systems.
- Maintained confidential records while handling sensitive patient and provider communications.
Special Pharmacy Liaison
UBC
Morgantown, WV
06.2023 - 04.2025
- Provided consistent and effective communication to all stakeholders as first line support and single point of contact with contracted specialty pharmacies and specialty distributors.
- Identify, investigate, and resolve escalated issues and cases related to complex reimbursement and/or REMS compliance from both internal and external stakeholders.
- Analyzed incoming data and recognized trends and cases that needed further action.
- Reviewed incoming daily data from contracted specialty pharmacies and specialty distributors, addressed exception errors from data feeds, and conducted outreach on outstanding restatements to ensure data integrity.
- Led weekly calls with each contracted specialty pharmacy and specialty distributor to review identified issues with shipment and patient status files.
- Tracked receipt of referrals, monitored status of contracted SP activity, and identified potential interruptions in therapy to facilitate timely interventions.
- Provide training and education to contracted SPs and/or SDs about the program, processes, and data requirements.
- Gathered, analyzed, and prepared data for Quarterly Business Reviews and Compliance Committee Meetings, ensuring compliance with FDA requirements.
Eligibility Specialist
UBC
Morgantown, WV
04.2022 - 06.2023
- Reviewed incoming referrals for completeness and confirmed FDA requirements were met.
- Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representative
- Provided billing and coding information for specific products
- Researched payer policies and practices to inform eligibility determinations.
- Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy.
- Participate in call center activities, triage, and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.
- May serve as single point of contact for an assigned group of prescribers.
- Effectively manage and work through action item list to ensure it is current and tasks are completed in a timely fashion.
- Maintained accurate documentation of inquiries to enhance customer service processes and mitigate legal risks.
- Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.
Coordinating Center Associate
UBC
Morgantown, WV
06.2021 - 04.2022
- Handled inbound and outbound contacts from various sources (patients, healthcare providers, etc.) related to specific UBC programs.
- Provide consistent customer service support to all stakeholders for the assigned program(s).
- Working knowledge of program guidelines, medication, or disease being referenced in call scripts.
- Completed follow-up on missing information from stakeholders, ensuring accurate data entry, documentation, and safety reporting per program guidelines.
- Apply corrections and/or updates in the secured program applications and/or CTMS and appropriate documents, which have been identified through data verification or follow-up calls.
- Escalate potential problems or issues that require management's immediate attention and provide a summary with appropriate detail to his/her direct supervisor.
- Documented communications in contact log accurately and concisely, adhering to Standard Operating Procedures.
- When applicable, may assist in the process to recruit or initiate sites and coordinate launch activities.
- Provide new and/or updated training materials as needed.
- Executed program compliance duties, providing re-education to stakeholders, documenting non-compliant events, and reviewing alerts/reminders for effective healthcare provider follow-up.
- Prepared program compliance materials for client meetings as needed.
- Prepared and shipped program materials while documenting actions within the appropriate applications as needed.
- Review documents for program standards and take appropriate action.
- Ensured accurate and timely completion of data entry, filing, and data confirmation.
Senior Reimbursement Specialist
UBC
Morgantown, WV
12.2014 - 04.2022
- Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representative
- Reviewed incoming referrals for completeness and confirmed FDA requirements were met. These are typically received via facsimile, Web portal or client partner download.
- Conducted thorough research on various payers to gather essential information.
- Provided billing and coding information for specific products to ensure accurate processing.
- Participated in call center activities, triaged and responded to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and home care agencies, ensuring seamless communication and support.
- Served as single point of contact for assigned group of prescribers, facilitating effective communication and support.
- Effectively manage and work through action item list to ensure it is current and tasks are completed in a timely fashion.
- Maintained accurate and complete documentation of all inquiries to enhance customer service processes and mitigate legal risks.
- Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.
- Executed additional tasks as directed to support team objectives..
Education
Bachelor of Science - Health Information Technology
Pierpont Community College
Fairmont, WV05-2025
Skills
- Patient access
- Prior authorization
- Insurance verification
- Case management
- Patient assessment
- Case documentation
- HIPAA
- Clinical guidelines
- Detail orientation
- Team collaboration
- Cross functional collaboration
- Interdepartmental collaboration
- Problem solving
- Therapeutic support
- Patient confidentiality
Certification
Certified Billing and Coding Specialist, May 2025
Timeline
Territory Case Manager
Cardinal Health
07.2025 - Current
Special Pharmacy Liaison
UBC
06.2023 - 04.2025
Eligibility Specialist
UBC
04.2022 - 06.2023
Coordinating Center Associate
UBC
06.2021 - 04.2022
Senior Reimbursement Specialist
UBC
12.2014 - 04.2022
Bachelor of Science - Health Information Technology
Pierpont Community College