Melinda Galette
Atlanta
Summary
Regulatory Compliance Analyst with extensive experience supporting large healthcare plans, including DMHC, DOI, CMS, HIPAA, Knox-Keene, and Medicare/Medicaid regulatory requirements. Skilled in audit readiness, grievance reporting, compliance documentation, corrective action planning, issue trending, and cross-functional collaboration across Legal, Appeals, Claims, and Quality teams.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Administrative Insurance Coordinator
Camp Creek Dental
01.2020 - 01.2021
- - Oversaw insurance workflows and documentation ensuring daily compliance and accurate claim processing.
- - Improved operational compliance through refined procedures and error-reduction methods.
Lead Treatment Coordinator
DentFirst Dental Care
01.2017 - 01.2021
- - Handled insurance verification, compliant documentation, and benefit interpretation.
- - Trained staff in HIPAA-aligned workflows and payer compliance processes.
Quality of Care Coordinator
Delta Dental
12.2025 - Current
- Analyze quality of care and service complaints using Microsoft Excel to track case details, identify trends, validate data accuracy, and monitor timelines for regulatory compliance.
- Utilize Excel filters, sorting, and data validation to review high-volume grievance and appeal data, ensuring completeness and consistency across case records.
- Review clinical and administrative documentation for accuracy and regulatory alignment; identify discrepancies and coordinate corrections prior to consultant and external review.
- Conduct research on applicable clinical guidelines, plan policies, and regulatory requirements (DMHC, DHCS, CMS, Knox-Keene) to support case determinations.
- Prepare clear, structured case summaries and data-driven findings for Dental Consultants and Quality leadership review.
- Support audit readiness by organizing, validating, and maintaining audit-ready case files and supporting documentation.
- Perform root cause analysis on recurring quality issues using data trends to support corrective actions and process improvements.
- Communicate determinations and resolutions professionally through written correspondence, ensuring clarity, accuracy, and confidentiality.
Regulatory Compliance & Escalation Coordinator
Delta Dental
01.2024 - 12.2025
- Manage escalated issues requiring regulatory oversight for DMHC, DOI, CMS, and internal compliance standards, using Microsoft Excel spreadsheets to track cases, monitor timelines, and maintain data accuracy across reporting logs.
- Conduct root-cause analysis utilizing Excel filters, sorting, and pivot tables to identify trends, anomalies, and systemic issues impacting grievance timeliness, appeals, and claims accuracy.
- Prepare and maintain compliance documentation for state audits, including Excel-based reconciliation logs, audit trackers, and evidence matrices to support internal and external reviews.
- Collaborate with Legal, Appeals, Quality, and Claims teams to resolve high-risk compliance cases, leveraging Excel summary reports and data tables to support review, validation, and decision-making.
- Analyze operational and compliance trends using Excel data validation, cross-referencing, and exception tracking, providing audit-ready insights and leadership reporting.
Insurance Claims Examiner II
Delta Dental
01.2022 - 01.2024
- - Processed high-volume claims with strict compliance to HIPAA, CMS, and Knox-Keene regulations.
- - Identified trends in claim denials and supported operational improvements tied to compliance.
- - Prepared audit documentation and validated claims accuracy for internal and regulatory review.
Deltacare Medicare Specialist
Delta Dental
01.2021 - 01.2022
- - Ensured adherence to Medicare and CMS regulations while supporting providers and members.
- - Resolved discrepancies identified during audit prep and compliance review.
- - Improved provider compliance accuracy through detailed guidance and documentation alignment.
Medical Scribe
Lake America Family Physicians
01.2014 - 01.2017
- - Maintained 100% accurate medical documentation following HIPAA and CMS standards.
- - Resolved documentation inconsistencies to reduce provider compliance risk.
Education
Master of Science -
Western Kentucky University
01.2024
Bachelor of Science - Health Science & Administration
University of Central Florida
01.2015
Skills
- Advanced Microsoft Excel & Data Analysis
- Regulatory & Policy Compliance
- Data Reconciliation, Accuracy & Exception Resolution
- Root Cause Analysis & Corrective Action
- Audit Readiness & External Audit Support
Certification
- Healthcare Data Security, Privacy, and Compliance
- The Critical Role of IT Support Staff in Healthcare
Timeline
Quality of Care Coordinator
Delta Dental
12.2025 - Current
Regulatory Compliance & Escalation Coordinator
Delta Dental
01.2024 - 12.2025
Insurance Claims Examiner II
Delta Dental
01.2022 - 01.2024
Deltacare Medicare Specialist
Delta Dental
01.2021 - 01.2022
Administrative Insurance Coordinator
Camp Creek Dental
01.2020 - 01.2021
Lead Treatment Coordinator
DentFirst Dental Care
01.2017 - 01.2021
Medical Scribe
Lake America Family Physicians
01.2014 - 01.2017
Bachelor of Science - Health Science & Administration
University of Central Florida
Master of Science -
Western Kentucky University