Medical Billing & Authorization Specialist
Resume:
Melanie Herrick
Medical Clinical/Office
Oroville, California
**************@*******.***
Medical Clinical/Office specialist improves billing accuracy by reviewing ICD-10 coding and posting payments and adjustments to reconcile accounts and reduce denials. Manages prior authorizations, PBM portal requests, and surgical scheduling to maintain patient access. Audits HIPAA-compliant call and documentation practices and resolves complex billing disputes. Employment history
Reimbursement
Specialist, Tandem
Diabetes, Aug 2001 –
Apr 2026
San Diego
Customer Service
Advocate, Healthcare
Support/Centene, Oct
2023 – Apr 2024
Sacramento
Case Manager,
TEKSystems, Apr 2022 –
Jun 2023
Sacramento
Medical Assistant (MA),
Northstate foot and
Ankle, Jul 2017 – Apr
2019
Chico
Skills
Authorizations, Referrals, Coding, Surgery Scheduling, Back Office Education
Oroville Adult School,
Oroville, Apr 2001 – May 2026
Certified Medical Assistant
To obtain my certification as Medical Administrative Assistant. Durham Vocational, Durham,
Jun 2000 – Aug 2000
Certificate
Medical office, Medical Terminology, and Medical Transcription. Oroville Adult School, Oroville, Jan 1998 – Jun 1998 Certified Nursing Assistant
Reviewed medical claims for coding accuracy using ICD-10 guidelines, reducing denials and rework.
Posted payments and adjustments in the billing system to reconcile patient accounts daily. Processing Refunds
Reconciled payer payments against contractual rates to detect underpayments for recovery requests.
Processed high-volume inbound calls using CRM software, closing inquiries and recording outcomes within prescribed SLA.
Resolved complex billing disputes for customers by researching account histories and issuing correct credits promptly.
Processed prior authorization requests through PBM portals, obtaining approvals and documenting outcomes.
Audited daily call logs for compliance with HIPAA standards, reporting discrepancies to quality assurance.
Determining eligibility requirements for state program. Moving cases to proper status after determining where the application needs to be sent. Exercise day-to-day oversight and perform compliance analysis procedures of the program. Following up with applicants to get documents
Prepared exam rooms, sterilized instruments, and stocked supplies to maintain daily clinic readiness.
Scheduled patient appointments, coordinated referrals, and confirmed insurance eligibility to reduce no-shows.
Prepared patient intake documentation in EHR, verified demographics and insurance before visits.
Set up minor procedure trays and assisted with wound debridement under clinician direction.
Scheduled Surgeries
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