TIMOTHY PAULING
Charlotte
Summary
Personable and dedicated Customer Service Representative with extensive experience in the customer service industry with over 20 years of experience. Solid team player with upbeat, positive attitude and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses.
Professional with extensive experience in processing pre-authorization requests for medical procedures, ensuring adherence to insurance guidelines and compliance standards. Demonstrated ability to verify patient eligibility and benefits coverage, collaborating effectively with healthcare providers to gather necessary documentation. Maintained accurate electronic records of pre-authorization activities while upholding HIPAA regulations to protect patient confidentiality. Developed a strong understanding of various insurance plans and policies, contributing to efficient workflow and improved operational processes.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Insurance Authorization Specialist
Robert half
Charlotte
07.2025 - 12.2025
- Reviewed and processed pre-authorization requests for medical procedures, ensuring compliance with insurance guidelines
- Verified patient eligibility and benefits coverage to determine if pre-authorization was required
- Collaborated with healthcare providers to obtain necessary documentation and clinical information for pre-authorization requests
- Maintained accurate records of all pre-authorization activities in the electronic database
Authorization Specialist
Centene
Charlotte
03.2025 - 06.2025
- Reviewed and processed pre-authorization requests for medical procedures, ensuring compliance with insurance guidelines
- Verified patient eligibility and benefits coverage to determine if pre-authorization was required
- Collaborated with healthcare providers to obtain necessary documentation and clinical information for pre-authorization requests
- Developed strong knowledge of different insurance plans, policies, and procedures related to preauthorizations
- Maintained confidentiality of patient information according to HIPAA regulations at all times
Claims Specialist
Epiq Global
09.2024 - 02.2025
- Initiated claims thru company website for claimants, updated spreadsheets for claims review.
- Closely monitored claims as they came thru portal for update and review.
Benefits Specialist
CareMetx, LLC
Charlotte
12.2023 - 08.2024
- Conducted thorough benefit verifications for patients, ensuring accurate and up-to-date insurance coverage information
- Collaborated with healthcare providers to obtain necessary documentation and complete the verification process in a timely manner
- Maintained detailed records of all benefit verifications, including insurance details, copayment amounts, and coverage limitations
- Developed strong relationships with insurance company representatives to facilitate smooth communication during the verification process
- Closely monitored changes in insurance policies and communicated updates to relevant stakeholders within the organization
Claim/ Prior Authorization Specialist
Evolent Health
Charlotte
03.2021 - 11.2023
- Researched claims information for members and providers.
- Coordinate benefits with claims.
- Requested, followed up and secured prior authorization prior to services being performed.
- Advise providers of Prior authorization being approved or denied.
- Educated and enrolled in online services.
Benefits Specialist
LASH GROUP
Fort Mill
07.2019 - 12.2020
- Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
- Monitored data integrity and confidentiality by observing strict regulations and procedures.
- Provided assistance to plan participants by explaining benefits information to ensure educated selections.
- Reviewed employee enrollments to verify accuracy, inputting all information into company's database.
- Juggled multiple projects and tasks to ensure high quality and timely delivery.
Senior Customer Service Specialist
IQOR
08.2013 - 07.2019
- Assessed customer needs and upsold products and services to maximize company sales.
- Assisted approximately 110 customers each day with questions and concerns.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Informed customers about billing procedures, processed payments and provided payment option setup assistance.
- Reviewed account and service histories to identify trends and issues.
- Documented conversations with customers to track requests, problems and solutions.
- Created and implemented process improvements to reduce workloads and bolster callback efficiency.
- Cultivated impactful relationships with customers and drove business development by delivering product knowledge.
- Delivered service and support to each customer, paving way for future business opportunities.
- Consulted with customers to determine best methods to resolve service and billing issues.
- Set up and activated customer accounts to maintain QA satisfaction levels.
Human Resources Specialist
TriNet-Charlotte
Charlotte
03.2016 - 08.2018
- Assist employees with their benefits, pay rate, also compensation.
- Assist with insurance plans details, dealing with benefit vendors, also assist with Employee Assistance Programs.
Department Manager
Harris Teeter
09.2000 - 09.2011
- Use computers to organize and locate inventory, and operate spreadsheet and word processing software.
- Negotiate prices, discount terms and transportation arrangements for merchandise.
- Confer with sales and purchasing personnel to obtain information about customer needs and preferences.
- Examine, select, order, and purchase at the most favorable price merchandise consistent with quality, quantity, and specific requirements and other factors.
- Monitor and analyze sales records, trends, or economic conditions to anticipate consumer buying patterns and determine what the company will sell and how much inventory is needed.
- Interview and work closely with vendors to obtain and develop desired products.
- Train or supervise sales or clerical staff.
- Determine which products should be featured in advertising, the advertising medium to be used, or when the ads should be run.
Education
High School Diploma -
GARINGER HIGH SCHOOL
Charlotte, NCSkills
- English
- Insurance prior authorization
- Telecommunication
- Electronic health records (EHR) management
- EHR systems
- Administrative experience within healthcare
- Clinic experience
- Excel data analysis
- Documentation review
- Medicaid
- Purchasing
- Insurance Verification
- Word processing
- Hospital experience
- Outpatient
- Behavioral health
- Strategic communications
- NCQA standards
- FMLA
- Computer literacy
- CPT coding
- Data entry
- Call center experience
- IV infusion
- Inpatient
- Conflict management
- Revenue cycle management
- Technical support
- Microsoft PowerPoint
- Microsoft Word
- Computer skills
- Medical claims processing
- Appointment scheduling
- Business Development
- Salesforce
- Bilingual
- Human resources
- Writing skills
- Network management
- Grammar Experience
- Contracts
- Communication skills
- Phone etiquette
- Sales
- DME
- Medical claims
- Outbound calling
- 10 key typing
- Time management
- Patient service
- Negotiation
- Financial services
- Benefits strategy management
- Windows
- Patient interaction
- ICD-10
- SQL
- Pivot tables
- Managed care
- Medical administrative support
- Healthcare billing management
- NextGen
- Document management systems
- Medicaid health insurance
- Remote technical support
- Macros
- Insurance claims auditing
- VLOOKUP function
- Workday
- Processing insurance claims
- Medical billing
- Phone communication
- Payroll
- Health insurance authorizations
- Discharge planning
- Customer support
- Insurance claim appeals processing
- Administrative experience
- Organizational skills
- Customer inquiry handling
- HIPAA
- Medical payer enrollment
- Securities law
- Internal controls
- Pharmacy technician experience
- Typing
- Computer operation
- Procurement
- Content management systems
- Medical office experience
- Ethernet
- Medicare regulations
- Athenahealth
- Ability to work under pressure in a fast pace environment
- Challenged by new responsibilities
- Quality readily adaptable to Changes
- Reporting
- Proven ability to work independently or with others
- Securities
- Microsoft word, Excel, Powerpoint
- Spreadsheet
- Advertising
- Tech Support
- Clerical
- Transportation
- Customer care
- Website
- Forms
- Inventory
- Excel
- Microsoft word Purchasing
- Vendor relationship management
- Medicare
- Quantitative analysis
- Microsoft Outlook
- Microsoft Excel
- HCPCS
- Appeals
- Productivity software
- Workers' compensation law
- Account management
- Technical Proficiency
- Banking
- Analysis skills
- Intake
- EMR systems
- Microsoft Office
- Insurance claim adjustments processing
- Utilization management
- Pre-authorization processing
- Insurance verification
- Claims management
- HIPAA compliance
Websites
Certification
- Senior Professional in Human Resources
- Professional In Human Resources
- Driver's License
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Timeline
Insurance Authorization Specialist
Robert half
07.2025 - 12.2025
Authorization Specialist
Centene
03.2025 - 06.2025
Claims Specialist
Epiq Global
09.2024 - 02.2025
Benefits Specialist
CareMetx, LLC
12.2023 - 08.2024
Claim/ Prior Authorization Specialist
Evolent Health
03.2021 - 11.2023
Benefits Specialist
LASH GROUP
07.2019 - 12.2020
Human Resources Specialist
TriNet-Charlotte
03.2016 - 08.2018
Senior Customer Service Specialist
IQOR
08.2013 - 07.2019
Department Manager
Harris Teeter
09.2000 - 09.2011
High School Diploma -
GARINGER HIGH SCHOOL