Arlene Scott

Experience

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  North American Medical Management

  Jan 2000 - Jan 2011

  Associate Executive Director, Provider Relations

  Managed daily operations for Commercial and Medicare Advantage HMO provider contracts affiliated with high-profile Independent Provider Association (IPA): Silver Cross Managed Care Organization. Oversaw all elements of relationship, from onboarding and training of portal and program provider manual to one-on-one physician consultations to address trends to increase overall key performance indicators, facilitation of monthly provider and Advisory Committee meetings, as well as bi- annual practice manager meetings held in large forum setting.Participated in client financial meetings, ensured accuracy and made recommendations for improvement accordingly, and initiated contract strategies, provider negotiations, and letters of agreement on case -by-case basis. Composed monthly provider newsletters for purpose of communicating changes to regulatory and operational procedures, such as new/changed billing code or introduction of new provider to organization. Met on-site every week with IPA's vice president and chief medical director to discuss accomplishments, issues, and risks related to contractual terms of entity contract.• Built relationships with executive leaders, primary care, and specialty providers/staff.• Led efforts to transition providers from manual to electronic claim submission and claim payment process.• Named NAMM's first-ever Employee of the Year in 2010. Show less

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  Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

  Jan 2011 - Jan 2020

  Created, built, and led overall integration of business strategies across all plans and business segments (group, government, and retail). Directed activities and deliverables of cross-functional teams, including network, healthcare management, legal, product, IT, and others, for analysis and internal outreach; championed stakeholder engagement and integration for delivery of organizational objectives to meet financial targets; and identified model enhancements to endorse changes in design. Retained overall oversight of end-to-end execution of new provider engagement solutions. Designed and implemented Affordability of Care and Fee for Value company initiatives. Integrated with third-party vendors to deliver alternative payment models and delegated utilization management requirements. Led overall project execution by engaging cross-functional matrix teams (network, healthcare management, legal, product, IT) and directing activities necessary to meet overarching project plan intent. Built and nurtured strong, trusting relationships with internal teams to champion stakeholder participation and ensure on-time, within-budget delivery. • Endorsed and socialized Provider Experience Framework and Insights Toolkit with cross-divisional teams responsible for provider enablement delivery imperatives to gain interest for partnered execution. • Led implementation of outpatient utilization management partnership project with eviCore healthcare. o Delegated management of prior authorization for outpatient services, such as radiation therapy, genetic testing, and imaging, resulting in significant reduction in avoidable treatment and costs based on medical care guidelines and proven health outcomes. • Spearheaded and served as point person for provider contract with Alacura Air Ambulance. o Ensured use of proper mode of transport based on health plan medical policy, resulting in significant reduction in medical spend and eliminating member cost share/surprise billing. Show less Executed and managed day-to-day operations for Medicare Advantage HMO/PPO and Medicare-Medicaid Alignment Initiative- based contracts, including root cause analysis and resolution of eligibility/claims issues as well as facilitating monthly Joint Operating Committee leadership meetings, along with preparing agenda/related materials. Managed audit team to ensure appropriate claims payment of services rendered and paid by delegated medical groups. Directed staff responsible for executing audit schedule, findings of audit generating corrective action plan, and resolution and closure of such findings.• Bridged relationships as liaison between high-profile medical groups, hospital systems, and payer.• Nurtured inter-departmental relationships, executed monthly strategic meetings with government program’s leadership teams, and presented education and reporting needs in parallel to developing provider agendas for Medicare Advantage,Medicare-Medicaid Alignment Initiative, and Medicaid contract entities. Show less Developed and implemented clinical, non-clinical, and system training policies and procedures for execution of Intensive Medical Home (IMH) value-based care delivery model. Managed and facilitated operations of multiple IMH provider group contracts, including onboarding and audit resource management of field nurse care managers, research and problem detection, root cause analysis to foster issue resolution, trend identification, and evaluation of high-profile/-impact providers to ensure achievement of all contractual and financial requirements.• Drove success of value-based care initiative by building and maintaining respected relationships with provider community (specifically with nurse care managers).• Trained and developed care managers to create care plans in partnership with attributed members, resulting in closure of several care gaps, as identified by goal setting. Show less

  • Director, Enterprise Network Solutions; Integration and Delivery

    Jan 2015 - Jan 2020

  • Sr. Manager, Government Program Contracting; Risk Based Networks

    Jan 2014 - Jan 2015

  • Provider Affairs Project Consultant, Professional Network Management

    Jan 2011 - Jan 2014
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  Centene Corporation

  Jan 2020 - Jan 2021

  Director Of Network Operations
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  Kempa Group Realty, Inc.

  Jul 2020 - Dec 2021

  Real Estate Broker
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  John greene Realtor

  Dec 2021 - Jan 2023

  Real Estate Broker
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  Keller Williams Preferred Realty

  Jan 2023 - Jan 2024

  Professional Realtor
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  VRS Village Realty

  Jan 2024 - now

  Real Estate Agent