Melaney Hatley

MELANEY HATLEY MANAGEMENT PROFESSIONAL A skilled management professional with over 18 years of experience in healthcare industry leadership. Leading cross-functional teams to deliver outstanding customer service, streamline workflows, and use data analytics to enhance service quality. Proficient in training, coaching, and mentoring staff, collaborating with other departments to exceed key performance indicators, and crafting personalized insurance solutions for client satisfaction WORK EXPERIENCE Career Break 11-2017 - 05-2024 From November 2017 to May 2024, I took a career break to manage family responsibilities and pursue academic growth. During this time, I honed skills in multitasking, adaptability, and problem-solving. I am now eager to return to the workforce with renewed purpose and a commitment to making a meaningful impact in my next role. Prior Authorization Specialist 03-2021 - 08-2021 Medix- Remote Approval and denials of prior authorization Contacting MD and staff first hand Handling Billing and Coding issues Adhering to policies and procedures for insurance platforms and plans Patient Services Representative 10-2020 - 02-2021 Mindlance-Remote General Program Inquires Determination for support programs (Copay, PAP, Medicaid, etc.) Pharmacy triage and coordination Order processing for wholesale orders Other follow-up activities (missing info, prior authorization, etc.) Intakes and reports adverse events as directed Patient Access Rep III Supervisor | Pharmacy Tech 10-2016 - 11-2017 Express Scripts-Tempe, US Facilitated cross-functional resolutions of drug coverage issues. Positively impacted revenue optimization through Process Improvement, leading to a 15% increase in revenue. Performed medical/pharmacy benefit verification requiring complex decision skills based on payer information. Served as a liaison, providing referral status reporting and negotiating pricing for non-contracted payers and authorized patient services. Utilized Leadership skills to handle escalations with discretion and discernment. Conducted Risk Assessments to ensure Regulatory Compliance and improve patient safety with Data Analysis. Pharmacy Service Representative 11-2015 - 05-2016  Phoenix, Arizona  - - linkedin.com/MelaneyHatley CVS Specialty Pharmacy-Chandler, US Coordinated and processed new and refilled shipments, ensuring Regulatory Compliance. Verified eligibility, prior authorization, and other reimbursement requirements before shipment, demonstrating strong Problem Solving skills. Assisted with enrolling and tracking the status of new customer referrals, utilizing Data Analysis for efficient processing, reducing processing time by 15%. Transferred and escalated clinical questions and issues to the staff pharmacist for resolution, contributing to Process Improvement. Provided explanations of specialty services to new customers and assisted with administrative and operations duties as required, showcasing Leadership abilities. Health Concierge Associate Team Leader 04-2014 - 11-2015 Atena- Scottsdale, US Resolved questions and issues based on phone calls/letters from members and providers, demonstrating problem-solving skills, achieving a 95% customer satisfaction rate. Documented and tracked contacts with members, providers, and plan sponsors, ensuring regulatory compliance. Managed incoming calls and handled requests for appeals in a call center environment, showcasing leadership and process improvement abilities. Reviewed member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductibles, utilizing data analysis skills. Benefits Analyst 12-2012 - 07-2013 CVS Caremark- Scottsdale, US Reconciled member accounts using data analysis, reducing discrepancies by 15%. Addressed grievances and appeals for the State of Arizona, ensuring regulatory compliance. Proficient in handling Medicare Part D, LEP, LIS, and PWO. Implemented new processes to improve efficiency, demonstrating process improvement skills. Conducted risk assessments to identify potential issues and mitigate risks. QUALIFICATIONS Skills Strategic Leadership Advanced Problem Solving Process Optimization Risk Mitigation & Assessment Regulatory Compliance Expertise Data Analytics & Interpretation EDUCATION Bachelor's 2023 - 2023 Northern Arizona University Flagstaff, AZ Major: Interdisciplinary Studies- Strategic Leadership Management Associate 2018 - 2022 Rio Salado Community College Tempe, Az Major: Applied Science Risk Management and Insurance Associate 2018 - 2022 Chandler-Gilbert Community College Chandler, AZ Major: Applied Science Organizational Management Associate Chandler-Gilbert Community College Chandler, AZ Major: Arts CERTIFICATIONS Risk Management and Insurance Organizational Leadership 2018 - 2022