Medical Specialist
Resume:
Stephanie Hall
Ripon, CA *****
***********@*****.***
EXPERIENCE
Health Plan Of San Joaquin, Modesto — Medical Claims Adjustment and Disputes Specialist
September 2022- November 2024
Processing, analyzing, and resolving complex medical insurance claims including high dollar contract claims and billing disputes. Responsible for investigating denied or underpaid claims, verifying coverage and coding accuracy, interpreting, payer contracts and policies, and submitting adjustments, appeals and reconsideration requests. Collaborated with insurance carriers, providers, and internal teams to resolve discrepancies, ensure regulatory compliance, and secure appropriate reimbursement. Maintained detailed documentation, tracking appeal outcomes, met strict deadlines, and provided clear communication to support timely and accurate claim resolution.
Health Plan Of San Joaquin, Modesto — Medical Claims Analysis
March 2019- September 2022
Reviewed and analyzed healthcare claims to ensure accuracy, compliance, and appropriate reimbursement. Evaluated medical documentation, billing codes, payer policies, and contracts to identify denials, underpayments, and discrepancies. Initiated corrections, adjustments, and appeals, and appeals while maintaining detailed documentation. Collaborates with providers, payers, and internal teams to resolve issues, improve accuracy and support revenue integrity.
Medical Billing & Coding Externship, Modesto — Temporary support/student clinic hours
September 2018- November 2018
Processed medical claims for hospital and physician services. Applied appropriate diagnostic and procedural codes, data entry of patient demographics, insurance details, provider information and billing codes within medical billing software systems.
SKILLS
Medical Claims
Analysis/Resolution
CPT, ICD-10/HCPCS
APR-DRG
Medical Assisting
Front & Back Office Operations
Insurance Denials, Appeals, &
Dispute Management
Payer Contract Interpretations
and Compliance
Revenue Cycle Management
Medical Documentation
Review & Audit Support
Provider & Customer Service
Support
Administrative Support
Clinical Procedures
Data Entry
Provider Scheduling
Central Valley Pain Management, Modesto — Medical
Assistant
September 2010- May 2013
Provided clinical and administrative support to physicians in a busy medical office. Ensured daily provider schedules were organized and exam rooms were properly cleaned, stocked, and prepared prior to patient visits. Collected documentation, patient vitals, medical history, records for examinations. Assisted in consultations, pre-operative visits, out patient procedures, specimen collection and administered injections as needed. Managed insurance authorizations, referrals, medical and workers’ compensation forms, collaboration with medical sales representatives. Prepared controlled substance prescriptions and medications. Valley Wellness Center, Modesto — Medical Receptionist April 2008- September 2010
Front office and clinical support to ensure efficient daily clinic operations. Managed incoming calls, patient check-in and admissions, physician scheduling, data entry, charting, and filing while responding promptly to patient inquiries and messages. Gathered and organized laboratory results and documentation of patients charts. Assisted providers with outpatient procedures and patient discharge. Handled in-office supplement sales, processed purchases, opened and closed the clinic, and balanced the cash drawer nightly.. Maintained inventory and stocked merchandise daily. HOYA Optical Laboratory, Modesto — Optical Receptionist June 2003- October 2008
Front office administrative support in a high volume medical laboratory. Managed a 25 multi-line phone system, greeted clients, scheduled appointments while delivering efficient customer service. Created and maintained accurate patient charts, updated demographics, and prepared prescription and lens orders. Verified prescription documentation, organized lenses for daily pickup. Data entry, filing, inventory, order tracking, and general administrative tasks as needed to support smooth clinic and lab workflow.
EDUCATION
California Institute of Technology, Modesto— Diploma February 2018
Abrams Medical College, Modesto — Diploma
October 2010
Johansen High, Modesto — Diploma
June 2003
Contact this candidate