T. Scott Gainer Email & Phone Number

Optum Health / Optum Care / Clinical Performance- Risk Adjustment Center Of Excellence

• Directed creation and management of continuous improvement regime in National CP Medicare Advantage Risk Adjustment businesses. Led leaders to create Process Risk & Controls Governance and Documentation Governance.
• Implemented a continual improvement regime for all CP businesses, utilizing existing control review touchpoints (scaled out from Coding Ops as noted in prior role).- Leveraged existing periodic process and control.
• Built and led CP Risk-Control Governance program.- Initiated and led risk assessment and process-control program in all national CP business Teams (scaled out from the initial Coding Ops program, noted in prior role.
• Created and led CP Documentation Governance (P&P, SOP, some Job Aids) effort. - Led team team of national leaders to determine and implement processes for document review and subsequent governance leadership team.
• Proactively aligned the two governance efforts and the continual improvement regime (as each is noted, above).

Optum Health / Optum Care / Clinical Performance National Medicare Risk Adjustment Management Team

• Led project management teams and consulting efforts with dozens of new market integrations, software implementations, and gap closure initiatives within CP national MA RA teams, as well as with CDOs and other matrix.
• Targeted processes improvement in all national coding team market processes.
• Assessed risk, documented controls and gaps, created new controls to close all gaps.
• Partnered with leaders for support with processes and risk mitigation.
• Implemented a new, elevated coding quality target producing new KPIs, tracking methods, and reporting interfaces.
• Operationalized new market coding team integrations, ensuring people-focus, increasing efficiency, and ensuring quality targets were met.

Optum Health- Optum Care, Clinical Performance- National Medicare Risk Adjustment Management Team

• Managed several software and IT Platform integrations, aligning national business capabilities with CDO partners.
• Was repeatedly tapped to take over struggling projects, rescuing projects by resolving issues; delivered high quality results while significantly bringing in schedules.
• Identified and closed key gap, avoiding HIPAA threat related to secure data releases of protected information including PII and PHI. - Created and managed Data Release Governance / Secure Release team “off the side of.

Optum Insight- Shared Services

• Provided consulting to and led many improvement initiatives with National management teams and CDO partners.
• Led a continuous improvements portfolio with new and existing Process Controls in all business areas of a vital, National, external facing comprehensive Medicare Risk Adjustment services group of businesses. - Led Risk.

Optum Insight- Shared Services

• Key member of the End-to-End Enterprise Enablement “Swat Team”; team of elite Project Managers focused on top tier gap closure and capability enablement projects aligning data and national capabilities with our new CDO.
• Led all privacy and several security workstreams for SOC2 audit readiness initiative.
• Consulted with the earliest Care Delivery Organizations for matrix improvements and led urgent response projects to close key gaps. - Led programs to improve provider adoption of Attestation programs, ensured no.
• Initiated a novel approach to inform providers of new member recapture and suspect health data prior to their first visit; pushed back with resistant leader to champion, succeeded by providing a viable method to create.
• Tapped to lead effort to repair significantly damaged relationship between the National teams and select market CDOs. - Embedded with the CDO with limited on-site visits and virtually to build relationships and.

Master Of Arts (M.A.), Biology Ed.

Undergraduate Studies

Activities and Societies: Winner of competitive academic scholarships including- Presidential Scholarship, Flora Corpening Scholarship.

Bachelor Of Arts (Ba), Science Ed.

This school was a college campus aligned under the WVU "University of West Virginia" umbrella while I attended and graduated.