Melanie Miller

• Oversee a team of 32 including 1 DOO, 3 Regional Managers, 25 Provider Reps and 3 Data Support Specialists
• Develop and implement SOPs for the entire Operations Department
• Develop & maintain positive relationships with providers, ensure provider adherence to contractual requirements, and educate providers and office staff on operations/policies and procedures, preventative & quality outcome metrics & risk adjustment
• Development, tracking, monitoring, and reporting on key program performance metrics, such as STARs, HEDIS, and other quality performance measures
• Work with providers & office staff to encourage membership growth & member retention
• Provide follow-up and intervention relating to provider complaints
• Perform initial educational orientation for all newly contracted providers
• Work closely with Contracting regarding provider changes, terminations, deficiencies, issues identified by providers, members, and internal staff
• Directed cross-functional teams for successful project completion, resulting in enhanced operational efficiency.
• Cultivated strong relationships with key stakeholders, fostering collaboration and partnerships for mutual success.
• Oversaw budget development and management, ensuring financial stability through cost control measures.
• Mentored junior team members by providing guidance on professional development opportunities and career growth paths.

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• As a PCC, I provided support to our Population Health Management group by working with a multidisciplinary team managing complex patient cases
• Consistent goals were to achieve improved overall patient health, increase satisfaction, and lower the cost of care
• Daily interfacing with the team and my providers to coordinate patient care, ensuring the delivery of a cost-effective, high-quality healthcare experience
• As a PTC, my focus was on transforming practices to allow them to engage and succeed in the new methods of reimbursement and the diversity of multiple-payer contracts
• I rendered education to providers and key practice staff on new quality metrics, and how to utilize these metrics to increase quality of care, while decreasing cost
• Additionally, I was involved in the development and implementation of a new computer platform, which was used internally by all teams as well as our clients
• I am well versed on many different EMR platforms including EPIC, Athena, Aprima, ECW, Medisoft, Digi, Amazing Charts, Talk EHR, NextGen, Practice Fusion, and Q Care, and can easily navigate payer portals
• In my promoted role as Performance Improvement Manager, I drove the transformation initiatives and performed constant evaluations of our growing population health partnerships, managing multiple value-based payer programs
• Responsible for planning, implementing, and evaluating quality, patient safety, and operational performance, collaborating with other managers, senior leadership, and team members to coordinate improvement efforts to meet outcome goals
• High focus on VBC Innovation, STARS, HEDIS
• Accomplished deliverable outcomes and driven results in performance and cost across our ACO, CIN, and IPA
• Management and oversight of over 200+ practices and 3 large health systems
• Management, training, and oversight of the Practice Transformation team to ensure successful outcomes and standardized performance results for all our value-based partners and programs
• Develop process improvement initiatives across payer programs, multiple practices, and physician groups
• Facilitate and execute cross-departmental and cross-functional process improvement initiatives, as well as rapid improvement projects requiring strong collaboration with clinical and operational leaders
• Identify and implement tools and processes that continually improve engagement, transformation activities, and communication with practices and payer partners
• Provide mentorship and coaching to team members in using Lean/Six Sigma or agile implementation methodologies
• Establish and maintain performance metrics to measure outcomes and program success in improvement initiatives
• Collaborate with leadership, peers, and frontline staff to effectively prioritize problem-solving
• Mentoring and training direct reports and new hires

• Before entering the healthcare field, I owned and operated 3 very successful businesses
• Responsibilities of this management position included providing leadership and guidance to a sales team of 10, and an employee base of 20, while also maintaining all financial aspects of the businesses
• Responsible for overseeing the financial and accounting system and personnel
• Prepared monthly budgets and financial statements
• Forecasted financial goals for each quarter to maintain the dealership’s sustainability
• In charge of screening and hiring all potential employees in all departments
• Met with the department managers regularly to review business matters and develop plans to increase profitability