MELINDA DYE
Grinnell,IA
Summary
Accomplished healthcare administrator specializing in prior authorization and compliance processes. Trains and mentors staff to improve workflows, resulting in heightened compliance and operational efficiency. Demonstrates a commitment to member-focused outcomes by swiftly addressing issues and ensuring optimal service delivery.
Overview
28
28
years of professional experience
Work History
Prior Authorization Pharmacy Technician
CENTENE CORPORATION
Remote
03.2015 - 08.2026
- Processed 23+ prior authorizations per shift while maintaining high standards of compliance and quality control.
- Resolved escalated member issues regarding missing or delayed medication orders, leveraging active listening and rapid problem-solving to maintain member satisfaction and continuous care.
- Resolved escalated member issues regarding missing or delayed medication orders, leveraging active listening and rapid problem-solving to maintain member satisfaction and continuous care.
- Resolved escalated member issues regarding missing or delayed medication orders, leveraging active listening and rapid problem-solving to maintain member satisfaction and continuous care.
- Trained and mentored staff on PA workflows and documentation standards, enhancing compliance and operational efficiency in pharmacy processes.
- Proactively escalated and resolved authorization and system issues, minimizing turnaround time and reducing rework.
Medicare Representative
Connextions
Orlando, FL
06.2013 - 03.2015
- Resolved inquiries and provided accurate benefit information to Medicare beneficiaries, contributing to high-quality service in a fast-paced call center.
- Managed high-volume inbound and outbound communications, assisting members and healthcare providers with service inquiries and care requests, maintaining 98% resolution rate on 50+ daily calls.
- Fostered strong member relationships through clear, empathetic communication, enhancing customer satisfaction across all interactions.
Prior Authorization & Precertification Specialist
WELLMARK HEALTH PLAN OF IOWA
Des Moines, IA
12.1998 - 04.2013
- Coordinated end-to-end prior authorization and precertification processes, collaborating with healthcare providers to expedite approvals and ensure timely access to covered medical services.
- Verified medical necessity, eligibility, and coverage parameters for PCP-to-specialist referrals through insurance payer guidelines, ensuring smooth care coordination for specialist services.
- Handled high-volume phone inquiries on pre-certification and pre-notification of medical services, providing clear guidance to members and healthcare providers to ensure compliance and understanding.
Education
Associate of Science - Occupational Therapy Assistant
Keiser University
Skills
- Prior authorization
- Team collaboration
- Compliance monitoring
- Medication therapy management
- Supply restocking
- Patient confidentiality
- Medicare and medicaid process
- Prior authorization processing
- Insurance verification
- Problem solving
- Attention to detail
- Conflict resolution
- Resolving customer issues
Personal Information
Timeline
Prior Authorization Pharmacy Technician
CENTENE CORPORATION
03.2015 - 08.2026
Medicare Representative
Connextions
06.2013 - 03.2015
Prior Authorization & Precertification Specialist
WELLMARK HEALTH PLAN OF IOWA
12.1998 - 04.2013
Associate of Science - Occupational Therapy Assistant
Keiser University