Jeffreann Melillo

****-* ******* ****** ***** Vista, CA 91915

619-***-****

advlvd@r.postjobfree.com

www.linkedin.com/pub/jeffreann-melillo/27/50a/2bb

Qualifications Summary

Leadership in Physician Network Development and Management, Community Relations, and Marketing Strategies

History of developing/executing Physician Network Management business and community strategies to increase revenue profitability, branding, visibility, as well as positive impacts in Provider Relations within new and existing healthcare industries

Effectively provide highest levels of communication and service to a broad spectrum of key stakeholders to include CEO’s, Medical Directors, Community leaders, non-profit agencies, employers, and strategic partners in the Healthcare industry.

Understanding of various elements of Health Care delivery to include Accountable Care Organizations and Clinically Integrated Networks.

NCCQA and HEDIS Quality Standards development & documentation.

Health Coaching, Scheduling, Population Health reviews by region.

UCSD Medical Group Clinical Practice Organization - Provider Enrollment Coordinator

March 2015- September 2022

Physician enrollment and database management

Provider Relations; Network Development to internal & external customers.

Focus on effective and efficient education outreach and expedient resolution of provider inquires as part of the Community Outreach team.

Develop and implement strategies to reduce member access grievances with contracted network providers.

Maintain Policies and Procedures and compliance with provider service procedures.

Access provider demographics compared to ratio of PCPs & SCP’s in region to meet geo-access standards.

Out of State (OOS) Medicaid Analyst: Register Primary Care, Specialists and Hospital by departments for multiple States to meet criteria prior to sending claims for reimbursement.

HealthCare Management and Consulting

2014 – 2015 Greater San Diego Area

Design and implement programs to build and nurture positive relationships between contracted physicians, ancillary providers and hospital facilities.

Act as a resource to ensure groups initiatives, regulatory requirements and strategic goals are realized.

Develop and implement strategies to reduce member access grievances with contracted network providers.

Focus on effective and efficient education outreach and expedient resolution of provider inquires as part of the Community Outreach team.

Maintain Policies and Procedures and compliance with provider service procedures.

Sharp Health Plan (SHP) Manager, Network Development/Provider Relations

2006- 2013

Development of strategies for Physician Network Management and Provider Relation across multiple sites within Sharp Health Plan and as liaison between providers, hospitals, ancillary services and Sharp Health Plan.

Provide training assistance to providers and their staff, to facilitate compliance with medical policies & procedures.

Identify gaps in specialty networks and initiate discussions with provider(s) to contract with Sharp Health Plan.

Managed three full-time staff members and provided credentialing and re-credentialing of providers to include site audits of office sites for providers and ancillary facilities for credentialing cycle with CVO’s at all contracted hospitals.

Provide Pharmacist and PBM’s with education out to providers related to formulary and/or policy changes as well as service recovery on any member related issues.

Provide yearly Provider Satisfactions Surveys

Member/Patient Satisfaction Surveys along with CAHPS measurement outcomes.

Development & Implementation of quarterly Joint Operations Committee meetings working closely with Directors and Physicians affiliated with Sharp Health Plan and our Delegated Medical groups.

Chaired Appeals & Grievances committee in accordance with Quality Measure Outcomes.

Hiring, counseling and performance evaluations of staff as well as the development of performance indicator accountability measurements.

Provide training and leadership for DMHC, HEDIS and NCQA Accreditation audits to include annual review and revisions of all Policy & Procedures (P&P’s) related to the Health Services department as well as P&P’s shared with other departments.

Developed implemented training on educational material to our delegated group providers, staff and key stakeholders aligned with Group Contracts.

Sharp Health Care (SDHA) Physician Marketing & Development Specialist

1999-2006

Development & implementation of physician marketing strategies in support of all Sharp hospital’s (Sharp Chula Vista, Sharp Grossmont, Sharp Coronado, Sharp Memorial) and medical groups with system-wide volume objectives. Place new physicians into existing medical practices

Troubleshoot physician issues and identify potential operational barriers.

Developed multi-disciplinary business strategies with primary care and specialty care physicians using strategies to maximize medical group and hospital payer mix.

Identify unaffiliated physicians and assist in aligning them with existing established practices with Sharp Medical Groups and Sharp hospital affiliations.

Coordinate and collaborate with hospital CEO’s and leadership teams in identifying key physician issues and creating solutions.

Coordinate customer service programs designed to influence physician admissions in assigned entities. Gain market intelligence regarding other organizations and their strategies to increase profitability.

Responsible for Management of provider contracting and physician network assessment to included establishing and maintaining a positive working relationship between SCMG and contracted physicians in the Grossmont, ChulaVista & Coronado regions.

Promoted solid working relationships with internal departments, insurance plans & Ancillary providers to facilitate communication and coordinate follow-up as needed for resolution of issues.

Serve as a liaison between providers and SCMG departments, hospitals, and HMO, PPO insurance group.

Conduct site reviews and orientations of new providers to SCMG, provided education, service with support to physicians and their office staff in regards to implementation and coordination of all managed care plans.

Market & promote SCMG business strategies to unaffiliated SCMG physicians to move established practices to SCMG, Sharp hospitals and affiliated providers.

Additional Training

Experience directing Operations and Business development for large physician groups that included Family Practice, OB/GYN and Dermatology with an emphasis in cosmetic & facial procedures with excellent patient quality outcome and satisfaction survey results. Experienced in Management of Personnel to include training of front and back office staff, employee reviews, and disciplinary action within Human Resources generalist guidelines. Interview and hiring of staff based on needs assessment for the practice.

Education

Graduate Degree -Master of Arts Organizational Management- University of Phoenix-San Diego

Bachelor of Science - Business Administration – SWC/University of Phoenix-San Diego

Community Service

Philanthropy and Non-Profit Organization

Committees

Access to Independence (A2I)

Kyoto Prize –Host Committee

San Diego Community College District- Corporate Committee Alternate

Urban League of San Diego (former Vice-President) - Diversity Council and Guild

Chicano Federation - La Cuna & Unity Luncheon

Membership Affiliations

Health Care Communicators (HCC)

National Organization of Professional Women

National Organization of University Women

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