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 programs covering all CP teams.• 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 reviews to identify new opportunities with matrix partners.• 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, below).- Utilized an original, value-based priority engagement method to avoid wasted effort or unnecessary changes. • 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 approval.- Identified opportunity to save leader valuable time and allow document approval at a time of their choice. -- Engaged report developer to build a basic application to automate leader voting.• 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 partners.CP National Coding Ops consulting example (>30 national-market processes):• 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.• Raised coding quality from 93% to 96.5%, over 9-months.- Achieved more complete and accurate member health information, increasing revenue and generating savings via fewer deletes/rejections and less re-work.• Conducted risk assessments and created well-controlled processes with all markets.- Ensured best in class processes and up to date, accurate, well-aligned process documentation (SOP & Job Aid level process flows w. key controls mapped & risk-control matrices for each process.- Established periodic updates for processes and risk-controls.• Established and led medical coding process and controls education and training effort with CP National Coding Ops leaders.- Achieved desired audit-ready state.• Initiated continual improvements regime for CP Coding Ops, leveraging the existing periodic process-control review touchpoints.; scaled out to all CP businesses.• Scrum Master with app development to automate and unify mixed auto/manual processes into one SAAS product, raising quality and efficiency.• Scrum Master with software dev. teams to create new apps, reporting, and enhance SaaS capabilities.• Integrated new CDOs into enterprise teams, applications, and systems.

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 my desk” for over 4 years, until a new automated enterprise solution was in place.- Partnered with key matrix business owners to build bridges and improve relationships for better alignment with common goals. - Established key medical coding and suspect platform forum. -- Hosted and facilitated the valuable forum for hundreds of senior leaders from various Optum and market-side businesses for over 5 years, across multiple roles, continuing to building on the positive relationships, before transitioning host responsibilities to platform owner.

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 Assessments and gap identification/closure efforts. - Improved many existing process and created efficient new processes.

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 partners- laying the groundwork for what would become the enterprise-level National Clinical Performance Risk Adjustment Management team. • 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 incentives were tied to agreeing or not with potential conditions, but only for responding completely. - Identified IPA provider pain points causing reluctance in adopting Attestation completion; resolved the pain points and increased adoption in all markets. • 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 a new LOB for partner entity to provide information as a service to all clients, legally and compliantly avoiding significant anti-trust concerns.• 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 identify pain points. -- Found common goals, built trust by easing pain points, built bridges, and created a true and enduring partnership replacing prior resistance and overall lack of engagement. -- Produced much improved matrix alignment, enabling a broad range of improvements tied to utilization of National capabilities to more completely and accurately identify and treat member health conditions.

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.