Scott Simms Email & Phone Number

Us

Responsible for the account management of all UHC self-funded (key and national accounts) clients regarding the most recent Out of Network Program (OON) Naviguard. Continued focus on reducing client spend and educating sales, account management, brokers and direct interaction with clients to increase affordability via interactive training sessions. Responsible for a book of business of approximately 6 million members.Regularly advise and help refine marketing materials as the Naviguard product evolves.Recognized as a SME in provider reimbursement.Lead weekly account management calls when needed to review and discuss client accounts experiencing difficulty with installation issues, claim adjustments, or in need of a custom solution to satisfy the client and support retention.Meet with Regional Vice Presidents to address any client concerns and report out on adoption progress on a bi-weekly basis, developing strategies to increase adoption of the Naviguard product. Maintain a sales and account management Sharepointsite, answering questions regarding the Naviguard product and directing operational requests to the appropriate resource when needed.

Minnetonka, Mn, Us

Responsible for the account management of all UHC self-funded (key and national accounts 50 – 3,000 lives+) regarding out-of-network programs focusing on reducing client spend and optimizing out-of-network programs. I regularly meet with key and national account clients, brokers, and regional sales/account management staff to advise and resolve out-of-network issues and evaluate potential strategies for savings. I regularly meet with legal staff, underwriting, and healthcare economics teams to ensure accuracy and downstream cohesion. I am considered a subject matter expert for out-of-network programs, regularly presenting to brokers and C-Suite client executives to understand their needs and recommend programs that align with their goals. Additionally, I analyze claims and financial trends to evaluate potential savings opportunities through various reporting programs.

Optum Maps - Responsible for business development for the Optum Maps geospatial suite of products, with a healthcare focus. Duties include writing statements of work, intersegment agreements, and ideating with potential customers to promote geospatial tools and analysis to improve existing or new business processes. Regularly use Salesforce to manage and track new business opportunities.myEasyBook Pilot - Responsible for the development of a provider network in AZ, TX and CO for the myEasyBook program. Duties included 300+ provider presentations, contract negotiation and execution, provider training, and claims oversight.

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Directed the account management of all retail providers for the Spectera Eyecare Network, which included 85+ retail chains including national accounts such as Walmart and Costco. Managed a staff both on-site and virtually of 6 employees, servicing network providers (customer service), provider acquisition, contract negotiation, and detailed claim reviews.

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Maintained and grew relationships with benefits brokers in Maryland and Virginia in the 51 - 3,000 life space selling dental, vision, life, and disability coverage. Regularly presented at finalist meetings with C-level executives, public officials, and employer groups in response to RFPs. Developed rates with underwriting team and worked with proposal and product teams to create benefit packages specific to client needs.

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Oversaw the billing, collections, payment processing, and accounts receivable (AR)for the Spectera Vision Network as well as commissions payments to sales staff. Also responsible for billing vision providers contracted with the Spectera Vision Lab, regularly negotiating payment terms with complex accounts. Managed a team of 10 employees, including 2 supervisors also responsible for decreasing AR and Days Sales Outstanding (DSO) metrics. Worked with various team across the organization including Six Sigma, Eligibility, and Information Management to implement 40+ process improvements

Silver Spring, Md, Us

Supervised staff and met with department heads to educate and develop new billing practices. Maintained the hospital Charge Description Master, updating rates and deleting obsolete codes to ensure accurate charges. Prepared the Health Services Cost Review Commission (HSCRC) Annual Filing and Medicare Cost Report. Negotiated with HSDRD and Medicare auditors to determine allowable charges, and represented the hospital at regular HSCRC policy meetings.

San Francisco, California, Us

Created a process/procedure to track and monitor loan portfolio loss activities, as well as created and maintained a loan loss database used for internal and external reporting. Prepared financial reports and analyses of loan loss reserves and presented findings to management on a monthly basisAuthored and maintained Sarbanes Oxley documentation of processes and workflows, ensuring compliance with corporate policy, supervised the creation of monthly journal entries, reviewed work of staff accountants for accuracy, and ensured adherence to timelines.

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Served as the financial representative for the analysis, controls, and decision making process dedicated to the Department of Defense TRICARE contract. Duties included vendor and sub-contractor management/negotiation, budgeting/forecasting, claims audits, and change order development. Also participated on a dedicated team focusing on the multi-billion dollar rebid of the newly established TRICARE regions.

New York, New York, Us

Executed and supervised financial statement audits, reviews, and compilations of health care and real estate clients. Prepared Medicaid and Medicare cost reports for health care providers (Skilled Nursing Facilities), analyzing and compiling financial data to project and advise on reimbursement issues. Prepared monthly and quarterly reconciliations for a variety of healthcare and real estate clients.