MEL HUGHES
Director
Fairfield,CA
Summary
SUMMARY OF QUALIFICATIONS: Recommends and implements policies and procedures to improve and maintain best practices in the billing and collection process. Extensive background in private and state/federal funded insurance carriers. Significant experience with commonly used legacy clinical and financial systems, PC's and commonly used software Experienced overseeing moves, telephone (communications) systems. Strong analytical abilities combined with excellent attention to detail. Ability to perform detailed work independently and manage time effectively. Self-motivated, strong job ownership, and ability to build existing client relationships and develop new ones. Strong leadership skills, managing and motivating clients, and ensuring a successful end product. Ability to manage multiple people and multiple tasks deftly. Ability to manage projects to a budget. Excellent communication skills (both written and verbal). Training development and presentation experience. Plans, delegates, and reviews work of financial counseling staff in the inpatient and outpatient settings.
Overview
53
53
years of professional experience
4
4
years of post-secondary education
Work History
Director Patient Access
OPTUM 360, Saint Francis Memorial Hospital
San Francisco, CA
06.2016 - Current
- Responsible for managing and administering multiple functions or managing general business operations
- Manage daily operations of various levels of staff and numerous functions/departments across one or more business units
- Day to day site operations, management leadership internal and external to the organization
- Accountable for financial and non-financial results (budgets and actuals)
- Project management and implementation, staff management
- Manages professional employees and supervisors
- Sets team direction, resolves problems and guides members of own team
- Oversee work activities of other supervisors
- Adapts departmental plans and priorities to address business and operational challenges
- Influences or provides input to forecasting and planning activities
- Product, service, or process decisions are most likely to impact multiple employees and customers (internal or external) groups
- Utilize standard project plan templates to create and tailor project plans to specific customers' needs
- Analyze RFP/contract language and incorporate requirements into project plans
- Assist internal and external business partners with completing tasks and resolving issues and problems with program implementation
- Establish and implement internal and external service level agreements
- Communicate with and help internal and external partners interpret contractual requirements
- Ensure effective problem solution and strategy implementation
- To drive effective business plan and sales strategy development, provide input to internal and external stakeholders (e.g., sales; shared business partners; pre-service vendors; facilities) to drive effective business plan and sales strategy development
- Seek feedback from customers to determine the success of overall project management and implementation Monitor project performance against internal and external service level agreements
- Work with internal and external partners (e.g., claims; call center) to ensure accurate reports are produced to validate the program
- Perform performance review
- Ensure performance is tracked accurately utilizing internal tools and processes (e.g., dashboards, scorecards, reports)
- Request and receive relevant performance data from internal partners and review for accuracy
- Manipulate provided data into practical tools and reports to facilitate performance review and analysis
- Review consolidated operational performance reports to determine overall effectiveness, make necessary changes, and identify opportunities for new programs or program consolidation or expansion
- Incorporate operations program performance information into strategic and business planning
- Delegate post-implementation tasks to appropriate stakeholders to fulfill RFP/contractual agreements
- Analyze operational performance on relevant criteria (e.g., targeted financial metrics; quality indicators; performance guarantees and incentives)
Patient Registration Supervisor/Methodist Hospital
Equity Staffing Group
Suisun City
12.2012 - 06.2016
- Supervise, monitor, and manage the daily operations of the Patient Registration Department to provide superior customer service and obtain the maximum reimbursement for services
- Supervise Day shift members of the department
- Participate in recruitment and selection of new hires, department orientation, and training and counseling of staff; in conjunction with the Site Manager, completes and processes probationary and scheduled appraisals for individual staff evaluations
- Monitor staff productivity and quality, develop and recommend changes in procedure and work assignments, and review and approve time cards for department personnel
- Responsible for interviewing and hiring applicants, evaluating employee performance, providing discipline, and counseling staff
- Provides guidance and constructively influences staff morale
- Possess an understanding of changes in federal and state regulations and the ability to revise procedures and processes accordingly and promptly communicate these changes to staff through continual training interfacing regularly with other units and departments within the hospital
- Assist in the Quality Improvement activities; assist in implementing and monitoring adherence to policies, procedures, standards, and objectives to provide the maximum level of quality and timely service to internal and external customers
- Works in collaboration with Department Managers and Directors to develop and implement integrated policies and procedures
- Maintains confidentiality of information deemed confidential and takes steps to assure processes that protect confidentiality
- Perform other duties as assigned, Provider
- Provides in-home nursing care for the client to include medication management and dispensing to ADL's
- Provides transportation and scheduling of appointments for all medical procedures.
Service Unit Manager
KAISER PERMANENTE Vallejo
Vacaville, CA
02.2013 - 02.2015
- Manage operations and actively assist and provide direction to support staff and providers within the Departments of Cardiology, Neurology, EKG, Multifit program, Pacemaker Clinic, Congestive Heart Failure Program, and Echocardiogram
- Instruct and implement new initiatives to increase customer service and improve workflows
- Champion lead for the blood pressure Hedis metric
- Support seasonal clinics such as influenza injection clinics
- Monitor access for provider schedules
- Monitors staff safety programs and Perform ongoing operational tasks, including managing the hiring, salary determination, and competency assessment processes
- Coordinate multiple projects, orchestrate meetings, and develop timelines
- Promote a team environment and provide work direction and guidance, including coaching, professional development, and training
- Resolve grievances using Labor Management Partnership
- Assists the Director with developing short and long-range departmental goals and objectives
- Administer budgets to meet the financial goals for capital, payroll, and non-payroll expenses; perform financial and staffing analysis
- Produce management information reports
- Review department/area performance to ensure that quality and quantity goals are met, including business and financial aspects
- Develop operating and customer service procedures
- Serve as a liaison between management, other departments, subordinates, and members
- Resolve problems and complaints from client departments, other managers, and members
- Ensure compliance with department/organization policies/procedures
- Conduct training sessions for professional development, systems training, and train-the-trainer program.
Service Unit Manager
KAISER PERMANENTE
Milpitas, Mountain View, CA
02.2010 - 02.2013
- Manage operations and actively assist and provide direction to support staff and providers within the Psychiatry Department
- Perform ongoing operational tasks, including hiring, salary determination, and competency assessment processes
- Coordinate multiple projects, orchestrate meetings, and develop timelines
- Promote a team environment and provide work direction and guidance, including coaching, professional development, and training
- Resolve grievances using Labor Management Partnership
- Assists the Director with developing short and long-range departmental goals and objectives
- Administer budgets to meet the fiscal goals for capital, payroll, and non-payroll expenses; perform financial and staffing analysis
- Produce management information reports
- Review department/area performance to ensure that quality and quantity goals are met, including business and financial aspects
- Develop operating and customer service procedures
- Serve as a liaison between management, other departments, subordinates, and members
- Resolve problems and complaints from client departments, other managers, and members
- Ensure compliance with department/organization policies/procedures
- Conduct training sessions for professional development, systems training, and train-the-trainer program.
Business Services Manager
SUTTER REGIONAL MEDICAL FOUNDATION
Vacaville, CA
08.2007 - 02.2010
- Develops and maintains current policy and procedure manuals for all Business Services functions
- Collaborates with Sutter Connect and Sutter Medical Foundation on any delegated functions to ensure compliance with regulatory agencies
- Works with Director to develop department goals and objectives and effectively communicate to staff
- Works with Director to prepare the annual budget and achieves budget targets established
- Defines Business Services department structure, position requirements, interviews, and selects new employees
- Assesses, develops, retains, and approves merit increases for staff within budget parameters
- Ensure compliance with department/organization policies/procedures
- Conduct training sessions for professional development, systems training, and train-the-trainer program
- Administer budgets to meet the fiscal goals for capital, payroll, and non-payroll expenses; perform financial and staffing analysis
- Utilize Quint Studer Methods such as AIDET to staff to improve and maintain excellent customer service.
SUTTER REGIONAL MEDICAL FOUNDATION
Vacaville, CA
02.2006 - 08.2007
- Appointment/Registration Supervisor duties include but are not limited to effectively resolving conflicts between individual needs of staff and organization requirements, screening, interviewing, and hiring applicants for the Appointment & Registration department
- Provides reports and feedback to staff managers and administration regarding organizational needs
- Participates in organization committees (Employee Recognition, Patient Satisfaction, etc.) Recognition and discipline of staff when appropriate
- Monitors good patient relations with random data and telephone audits
- Performs orientation and on-the-job training of employees by conducting IDX and insurances courses and auditing efficient registration data entry
- Lead staff meetings to assure staff are aware of the organization's business plan and provide one-on-one and group feedback of appointment activity performance
- Conducting Quarterly audits on all direct reports for quality assurance purposes and ongoing career development and training with staff
- Attends administrative or skills course(s) annually to stay current and enhance overall performance as a supervisor
- Actively participates in any modifications and updates of existing computer databases and is a key liaison to the organization's billing vendor
- Creates materials for new employee orientation and conducts training monthly
- Efficiently resolves and or reassigns billing issues related to patient billing with organizations billing service by telephone or fax, interpreting patients' concerns verbally or written
- Attends supervisory meetings to communicate appropriate policy and proceeds to staff and patients to prepare appointments, referrals, and facility services
- Initiates collaboration of doctors' schedules with clinical staff when scheduling and or rescheduling appointments
- Works in conjunction with clinical staff to optimize patient encounters by attending practice meetings, analyzing operational flow, and communicating clear understanding of proper administrative support procedures.
Local Area Manager /Local Office Manager
BAYSIDE MEDICAL GROUP
Walnut Creek, Berkeley, Alameda, CA
02.2001 - 11.2005
- Provided patient services, medical assisting/nursing, and patient counseling
- Personnel management, staff development and training, payroll, strategic planning, inventory management, marketing, Recruiting, hiring, development, and evaluation of staff
- The promotion included all previous duties with additional duties including managing three Local Office Managers
- Provided training for new managers and acted as a liaison between Clinicians and administrators
- Conducted strategy meetings with doctors and staff members
- Responsible for all safety inspections and audits performed by various insurance agents
- Provided OSHA training and inspections and created a HIPPA program
- Understand and use data and statistical information to improve the process
- Kept up-to-date systems and technology to promote cost-effective utilization of resources.
Team Leader Non-Commissioned Officer
UNITED STATES AIR FORCE RES, NCO
Travis AFB
07.1990 - 01.2005
- Recognized and promoted to organize and lead unit members in both wartime and peacetime operations
- Posses and instructs personnel in various leadership areas such as Conflict Resolution and Time Management
- Certified as an instructor for EMT, CPR, Total Quality Management, and Airman Leadership Training
- Performed duties as mental health technician, such as assisting with various groups and activities
- Observe and record patients' behavior as well as vital signs and intake/output records
- Maintains a safe and therapeutic environment for patients and staff
- Perform EKGs, provide immunizations, prepare lab slips, and collect blood, urine, stool, and throat cultures
- Perform vital signs routinely and accurately
- Certified in MAB and other personal protective tactics
- Received numerous awards and decorations such as Meritorious Service, Outstanding Unit, Air Force Longevity
Personnel Manager
REWARDS 2K.COM
Oakland, CA
02.2000 - 02.2001
- Duties include staffing and coordinating overseas teams for the website's day-to-day operations
- Performed all administrative functions, including shipping and receiving.
Office Manager/Staffing Coordinator
WALNUT CREEK HOSPITAL
Walnut Creek, CA
10.1998 - 02.2000
- Current duties include Staffing a 60-bed psychiatric facility
- Completed Denial of Rights reports
- Gathers and completes Outcomes Measurement reports
- Coordinates all staff training and other meetings and participates in management meetings
- Act as a liaison to the Director of Clinical Systems and CEO and CFO
- Order all medical as well as office supplies
- Complete and maintain FTE reports (Full Time Employee)
- Type various memos, letters, and reports
- File and maintained Title 22 binders, handled heavy phones efficiently and courteously
- Use multiple computer software applications such as Word, Excel and PowerPoint, and the World Wide Web
- Familiar with Data Storage Systems provided by EMC
- Work closely with outside agencies to provide cohesion and continuity
- Work closely with Human Resources and other Department Managers
- Responsible for A/R and A/P.
Assistant Office Manager
CVI MEDICAL GROUP Mtn
, CA
06.1997 - 10.1998
- Duties included front office registration, billing, collections, Emergency crisis mgmt, reception, and heavy phone operations
- Back office as a DOD Certified Medical Assistant to include nursing duties such as vital signs, immunizations, laboratory technician, physical exams, EKG, operate closely with the physician to assist with referrals and authorizations with insurance companies.
Staffing Coordinator
INTERIM HEALTH CARE
Sacramento, CA
05.1997 - 10.1998
- Provide staffing for In-Home health patients for offices in Sacramento, Grass Valley, and Placerville
- Utilized reception skills for all incoming calls to these offices and directed crisis Management calls to applicable services.
Team Chief of Adolescent Unit Assistant Program
SUNRIDGE HOSPITAL
Yuba City, CA
10.1992 - 10.1996
- Director provided a therapeutic environment for adolescent patients, including planning, implementing, and monitoring instruction and safety manuals
- Assisted physicians with formal and informal groups and activities
- Provide testing such as MMPI, Shipley Institute of Living Scale, Wechsler Adult Intelligence Scale, and TOVA
- Perform EKGs, vital signs and record shift-by-shift observations.
Clerk II
SAN BERNARDINO COUNTY Ontario
, CA
09.1990 - 09.1992
- Documents and vouchers in the Department of Social Services
- Performed Reception Duties, often utilizing limited Spanish speaking skills
- Data Processing of emergency items
- Various clerical duties.
Airman/Senior Airman Inventory Management Specialist
UNITED STATES AIR FORCE
Norton AFB
06.1986 - 07.1990
- In charge of Defense Reutilization Management Office Program
- Provided various office duties, data processing, filing, sorting, copying, typing 40 wpm, staffing airman for details and training and augmented other areas of supply such as warehouse and Individual equipment
- Managed the movement of materials worth more than $100,000.00.
Education
Doctorate Health Administration - Health Administration
Virginia University of Lynchburg
Lynchburg, VA 12.2020 - 12.2021
MBA - Business Management
University of Phoenix
Tempe, AZ 07.2005 - 07.2007
Bachelor of Science - Business Administration And Management/e-Business
University of Phoenix
Tempe, AZ 10.2001 - 10.2002
Associate Degree - Allied Nursing Services and Psychology
NCO Leadership School
Managerial / Supervisory courses, Safety courses, Customer Care Class, Total Quality Management courses, Effective Writing course. AIDET training and various labor relations courses. - undefined
Skills
Patient education and counseling
undefinedTimeline
Doctorate Health Administration - Health Administration
Virginia University of Lynchburg
12.2020 - 12.2021
Director Patient Access
OPTUM 360, Saint Francis Memorial Hospital
06.2016 - Current
Service Unit Manager
KAISER PERMANENTE Vallejo
02.2013 - 02.2015
Patient Registration Supervisor/Methodist Hospital
Equity Staffing Group
12.2012 - 06.2016
Service Unit Manager
KAISER PERMANENTE
02.2010 - 02.2013
Business Services Manager
SUTTER REGIONAL MEDICAL FOUNDATION
08.2007 - 02.2010
SUTTER REGIONAL MEDICAL FOUNDATION
02.2006 - 08.2007
MBA - Business Management
University of Phoenix
07.2005 - 07.2007
Bachelor of Science - Business Administration And Management/e-Business
University of Phoenix
10.2001 - 10.2002
Local Area Manager /Local Office Manager
BAYSIDE MEDICAL GROUP
02.2001 - 11.2005
Personnel Manager
REWARDS 2K.COM
02.2000 - 02.2001
Office Manager/Staffing Coordinator
WALNUT CREEK HOSPITAL
10.1998 - 02.2000
Assistant Office Manager
CVI MEDICAL GROUP Mtn
06.1997 - 10.1998
Staffing Coordinator
INTERIM HEALTH CARE
05.1997 - 10.1998
Team Chief of Adolescent Unit Assistant Program
SUNRIDGE HOSPITAL
10.1992 - 10.1996
Clerk II
SAN BERNARDINO COUNTY Ontario
09.1990 - 09.1992
Team Leader Non-Commissioned Officer
UNITED STATES AIR FORCE RES, NCO
07.1990 - 01.2005
Airman/Senior Airman Inventory Management Specialist
UNITED STATES AIR FORCE
06.1986 - 07.1990
Associate Degree - Allied Nursing Services and Psychology
NCO Leadership School
Managerial / Supervisory courses, Safety courses, Customer Care Class, Total Quality Management courses, Effective Writing course. AIDET training and various labor relations courses. - undefined
Similar Profiles
Kamry ZhangKamry Zhang
RN Care Coordinator at Saint Francis Memorial HospitalRN Care Coordinator at Saint Francis Memorial Hospital
Albina GuerreroAlbina Guerrero
RN Gastroenterology at Saint Francis Memorial HospitalRN Gastroenterology at Saint Francis Memorial Hospital
Chelsea HinderleiderChelsea Hinderleider
Burn ICU Nurse at Saint Francis Memorial HospitalBurn ICU Nurse at Saint Francis Memorial Hospital
Raphael DelainRaphael Delain
CNC Operator at Tronex TechnologyCNC Operator at Tronex Technology
Lisa CruzLisa Cruz
Patient Financial Coordinator at American Canyon OrthodonticsPatient Financial Coordinator at American Canyon Orthodontics