Melissa Garza
Austin,TX
Summary
Disability adjudication specialist with 3+ years of experience analyzing medical records and applying regulatory guidelines to achieve cost-effective outcomes. Expertise in medical record evaluation, discrepancy identification, and evidence-based decision making in high volume settings. Collaborates effectively with healthcare providers, legal representatives, and claimants to resolve issues and facilitate case resolution.
Overview
7
7
years of professional experience
Work History
Disability Specialist III
Texas Disability Determination Services
Austin, TX
02.2023 - Current
- Analyze complex clinical documentation to assess medical severity, functional limitations, and eligibility under federal guidelines
- Manage a high-volume caseload of 120+ claims, reviewing medical records, treatment history, and vocational data to support timely and accurate determinations
- Apply structured guidelines and evidence-based reasoning to make determinations with direct financial impact
- Identify discrepancies, missing documentation, and inconsistencies in medical evidence; proactively follow up with healthcare providers to resolve and reconcile issues
- Communicate regularly with providers, claimants, and representatives to obtain records, clarify findings, and drive case progression
- Maintain detailed, audit-ready documentation while consistently meeting productivity and quality benchmarks
- Navigate conversations with individuals experiencing financial hardship, demonstrating empathy while maintaining clarity and forward progress
- Train and mentor new adjudicators on case analysis, documentation standards, and workflow efficiency
ABA Therapist / Trainer
ChAMP Inc.
Austin, TX
09.2019 - 01.2023
- Delivered individualized behavioral therapy for pediatric/adult patients using Applied Behavior Analysis (ABA) methodologies
- Analyzed behavioral data to assess progress and refine treatment plans
- Collaborated with interdisciplinary teams and caregivers to enhance patient outcomes
- Built strong rapport with patients and families, often in high-stress or emotionally sensitive situations
- Trained new staff on treatment implementation and communication strategies to ensure compliance with clinical documentation standards
Education
Bachelor of Science and Arts (BSA) - Neuroscience
The University of Texas At Austin
Austin, TX05-2019
Skills
- High-volume case management
- Claims Review
- Medical documentation analysis
- Data analysis
- Policy Interpretation
- Conflict resolution
Timeline
Disability Specialist III
Texas Disability Determination Services
02.2023 - Current
ABA Therapist / Trainer
ChAMP Inc.
09.2019 - 01.2023
Bachelor of Science and Arts (BSA) - Neuroscience
The University of Texas At Austin