Scott Walkiewicz Email & Phone Number

San Francisco Bay Area

Healthcare consultant with provider and payor experience, highly experienced with health plan operations.Recent client engagements include: Program Manager for a multi-state Health Plan expanding Medicaid services in Virginia to offer MLTSS and other Waiver Services for high-intensity members. DSNP product implementation support for a regional Medicaid Health Plan expanding into new LOBs. Project Management for a multi-state Behavioral Health Provider… Show more Healthcare consultant with provider and payor experience, highly experienced with health plan operations.Recent client engagements include: Program Manager for a multi-state Health Plan expanding Medicaid services in Virginia to offer MLTSS and other Waiver Services for high-intensity members. DSNP product implementation support for a regional Medicaid Health Plan expanding into new LOBs. Project Management for a multi-state Behavioral Health Provider redesigning Rev Cycle org structure and updating departmental work queue management software capabilities. Business process consulting for a software development project using the Scaled Agile Framework to develop a Configure, Price, & Quote (CPQ) tool for a national health plan. Assessment and business plan development for a product pricing structure overhaul at a non-profit. Assessment and optimization recommendations for a community health system's medical staff agreement negotiation process. Interim Network Contracting Director for a Health System taking full-risk on two new MA Products. Successfully contracted downstream providers in 10 counties to meet CMS adequacy. Assessment and reorg recommendation for an integrated delivery system's downstream provider contracting functions. Workload model assessment for a Sales and Account Management department experiencing substantial growth and struggling to keep pace with volume demands. Conducted current state analysis of pain points and recommended optimal go-forward staffing plan. Implementation lead for a national expansion of a pilot program optimizing B2C engagement at Enrollment events. Developed a comprehensive training program for Provider Relations employees of a managed Medi-Cal health plan that included remedial training for existing employees and a new hire training program for future employees. Show less

Louisville, Kentucky Area

Responsible for all provider network operations including contracting & recruitment, provider relations, customer service, directories, credentialing, network access, and vendor services for newly created local PPO Network. Additionally, I managed leasing negotiations and the relationships with the TPAs that provide ASO services for our self-funded clients.Responsible for network sales in conjunction with the producers at the brokerage firms that have partnered with our network as well… Show more Responsible for all provider network operations including contracting & recruitment, provider relations, customer service, directories, credentialing, network access, and vendor services for newly created local PPO Network. Additionally, I managed leasing negotiations and the relationships with the TPAs that provide ASO services for our self-funded clients.Responsible for network sales in conjunction with the producers at the brokerage firms that have partnered with our network as well as the sales/marketing arm of the TPAs that administer the benefits for our clients. I coordinated sales targets and client followup & facilitate sales meetings with clients in conjunction with the brokers.Managed all network requirements for the Patient-Centered Medical Homes (PCMH) that we provide for our clients, including on-site and near-site employer-sponsored PCP services, on-site pharmacy dispensing, wellness/preventive integration, and integrated health delivery mechanisms.Participated in the development of the health system ACO footprint and integrated health delivery system. Show less

Louisville, Kentucky Area

Provided objective assurance, consulting, and business advisory services that evaluate and improve the effectiveness of risk management, control, and governance processes related to the Medicare segment.

Louisville, Kentucky Area

Negotiated and administered contracts with hospitals, physician groups, and other healthcare providers.• Responsible for maintaining a network of providers for commercial and Medicare products.• Analyzed reimbursement proposals; maintained targeted trend goals. Achieved a .98% repricing factor in January 2009 & 2010.• Administered contract terms and conditions, including inflationary adjustments, price protection, and terminations.• Maintained working relationships with key… Show more Negotiated and administered contracts with hospitals, physician groups, and other healthcare providers.• Responsible for maintaining a network of providers for commercial and Medicare products.• Analyzed reimbursement proposals; maintained targeted trend goals. Achieved a .98% repricing factor in January 2009 & 2010.• Administered contract terms and conditions, including inflationary adjustments, price protection, and terminations.• Maintained working relationships with key provider staff, consulting firms, and billing organizations. Troubleshoot claims issues and performance problems, added/removed providers from practices, and coordinated internal resources to serve provider needs.• Functioned as an active member on internal, cross-discipline work teams including: non-par surgical assistant task force, Health Department contracting initiative, and Medicare Advantage contracting. Show less

Louisville, Kentucky Area

Negotiated and administered contracts with networks, insurance companies, and other payers.• Held main responsibility for negotiating profitable contracts for health delivery system, including hospital, a multi-specialty physician group, urgent care centers, and other ancillary services.• Collaborated with analysts to develop and maintain pricing models for reimbursement.• Evaluated contract and payer performance; revised payment terms or methodologies as needed.• Prepared… Show more Negotiated and administered contracts with networks, insurance companies, and other payers.• Held main responsibility for negotiating profitable contracts for health delivery system, including hospital, a multi-specialty physician group, urgent care centers, and other ancillary services.• Collaborated with analysts to develop and maintain pricing models for reimbursement.• Evaluated contract and payer performance; revised payment terms or methodologies as needed.• Prepared credentialing and re-credentialing applications or other documentation to demonstrate compliance.• Accountable for maintenance of purchasing calendar, contract database, billing software updates, and a manageable filing system. Show less

Louisville, Kentucky Area

Held full recruitment responsibility for over 40 departments in a large community hospital.• Coordinated web-based and traditional applicant flow to management for nursing, allied health, and service departments.• Functioned as consultant for management in areas of candidate selection, position control, and employee relations.• Customized HRIS (applicant tracking software) for enhanced reporting and measurement.• Maintained positive relationships with academic, professional, and… Show more Held full recruitment responsibility for over 40 departments in a large community hospital.• Coordinated web-based and traditional applicant flow to management for nursing, allied health, and service departments.• Functioned as consultant for management in areas of candidate selection, position control, and employee relations.• Customized HRIS (applicant tracking software) for enhanced reporting and measurement.• Maintained positive relationships with academic, professional, and peer organizations. Show less

Louisville, Kentucky Area

Coordinated functional activities of a service department within a 400+ bed community hospital.

Mba, Business Administration

Bachelor'S, Biology

Education record