Scott Powell Email & Phone Number

Pittsburgh, Pa, Us

Pittsburgh, Pennsylvania, Us

Chicago, Il, Us

West Mifflin, Pennsylvania, Us

West Mifflin, Pennsylvania, Us

Dynamic, well rounded leader with cross functional experience in IT, operations and general management. Known for driving accountability and a sense of urgency throughout operations, building internal and external relationships, and developing and managing strong external partnerships. Unique and diverse background in IT and Operations provides for strong problem solving skills with the ability to get into the weeds and understand end to end processes. Has successfully led large migrations and projects from both an IT and Operations standpoint domestically and abroad. Currently responsible for operations, compliance and human resources of a fast growing, customer centric RCM business.

Us

Responsible for oversight and direction of captive and vendor resources, both domestic and abroad, supporting front and backend transaction operations.Ongoing support of ramp for Medicare transaction processing. Exceeded ramp schedules by surpassing staffing requirements 9 months ahead of plan, and setting up for growth beyond original plan. Oversight of 6 international vendors in Philippines, Guatemala, Mexico, India and China, executing over 90M transactions annually, 2,500+ FTEs and $70M annual spend. Driving improvements to increase quality through six sigma methodologies.Implementing standards across international vendor operations to ensure competitive balance, effective forecasts and metrics, and establishing platform for growing offshore operations.

Us

Direct activities of production units processing Medicare Advantage and Medicare Supplement transactions; including enrollment, billing, claims and customer service1.5M enrollments/year, and 5M claims Led turnaround of underperforming teams through significant culture and operational change to consistently meet or exceed all customer and CMS SLAsDrove significant improvements with relationships with internal and external customers, thus achieving all at risk performance guarantees and earning contract extensionsResponsible for site restructure, and conversion to 100% full work at home operation, including development of new production and quality monitoring and tracking toolsDeveloped teams with highest employee engagement scores (91%) in employee satisfaction surveys Drove system enhancements to increase Auto Adjudication over 20% and eliminate manual handoffs. Responsible for two Medicare/Medicaid TPA arrangements, covering 275,000 lives and $20M in revenue Business lead to assess and implement offshore transaction processing operations for claim, billing and enrollment. First year ramp up of 190 EEs, with plans for 250+ more over next 2 yearsTeams consistently exceed production and quality targetsAchieved cost savings of over $4M year 1Vendor Relationship Owner for multiple mail and data capture vendors $20M+ annual spend, and 25M transactions annually. Led selection and transition of 3 mail vendor migrations to drive productivity and functionality through new imaging and workflow tools. Projects resulted in savings of over $3M Partnered with vendors to drive ongoing process improvement and contract structures to reduce spend by $1.8m annually in 2010 with plans for additional reduction of 15% in 2011 and 2012Developed a pricing rebate program with vendor worth between $500K and $2.5M beginning in 2011

Us

Medicare Part D Implementation (2005 - 2006)Business lead for Implementation of 3 call centers to support the new Medicare Part D program (1,100 Customer Care Advocates)Responsible for site development efforts including hiring, training and local government interfaces for financial incentivesLed efforts to develop new application subsystems to capture enrollments via phoneDirector, Claim Operations - Medicare Supplement Claim, Correspondence, and Level 2 Call Center (2003 - 2005)Increased productivity by 22% through implementing new mail room and imaging solutions, workflow tools, paperless processing, and ongoing process improvements. $2M savings first 18 months.Implemented progressive production and quality standards to increase customer experience, and provide career path opportunities

Us

Extensive experience with application development and project management, including implementation of auto-adjudication and financial systems, EDI standards, and developing interfaces and automation between internal and external entities, including all Medicare carriers and multiple vendors

Managed new development and maintenance of computer systems to automate processing of health care claims. Responsible for all phases of project lifecycle from project definition to implementation.Responsible for negotiating and executing annual contracts worth $17 million with 32 government contractors.Implemented processes and systems to increase Electronic Claim volumes from 600,000 claims in 1991 to over 35,000,000 claims in 1996. Implemented processes and systems to increase the adjudication rate from 0% in 1991 to 90% in 1997.

IT lead for Transition of $4B business from Prudential to UnitedHealth Group, with focus on Claim, Financial, Letter Writing and Data Warehouse applications.Applications supported over 65 million claims, 33 million checks and EOBs and 600,000 letters annually. Developed systems and processes to take Auto Adjudication from 0% to 90+%Accountable for project delivery of up to 5 concurrent projects and all day to day system support activities, including vendor interfaces, project prioritization and staff development. Consistent track record of delivering projects on time, within budget and within scope.

Managed team responsible for maintaining production computer systems. Responsible for all batch and online systems, and ensuring system availability for customers.

Application developer responsible for design, analysis, programming, quality assurance and implementation of mainframe computer applications

Bs, Computer Science

Bachelor Of Science, Computer Science