Allison Scull
Summary
Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Overview
19
19
years of professional experience
Work History
Health Insurance Specialist-Project Manager
CMS Innovation Center (CMS-CMMI)
07.2024 - 02.2025
- Developed and maintained collaborative, supportive relationships within and across CMMI/CMS cross-functional groups
- Project managed a multidisciplinary team in executing the CMS Transforming Maternal Healthcare (TMaH) model, ensuring alignment with federal healthcare regulations and policy objectives
- Ensured compliance with CMS guidelines while optimizing workflows for greater efficiency and policy adherence
- Developed and trained TMaH team members on streamlined workforce platforms
- Created and maintained TMaH records management system for model visibility to provide to external contractors & CMS leadership
- Served as contractor liaison to external contractors acting as a point of contact for facilitating clear model guidance, project management & goal alignment
- Completed 16-hour Microsoft Project training essential to tracking TMaH objectives, deliverables, workflows & progression of the model
- Organized and facilitated model-related cross-functional meetings to ensure consistency across model communication and implementation
- Demonstrated preparedness for meetings by actively sharing ideas and participating in staff meetings, effectively tailoring presentations to both internal and external stakeholders
- Acted as a Project Officer for the TMaH model liaising between the model team and state awardees
Senior Regulatory Compliance Analyst
CareFirst BlueCross BlueShield
10.2021 - 06.2024
- Oversaw Affordable Care Act (ACA) Open Enrollment timelines with cross functional areas to include Operations, Enrollment, Communications and IT Operations confirming state mandated deadlines are met
- Governed ACA Open Enrollment status touchpoints to disseminate real-time updates to over 80 stakeholders throughout the Open Enrollment period
- Managed mass mandated ACA Open Enrollment Renewal Letter release for Maryland, D.C
- And Virginia for over 200,000 CareFirst members
- Collaborated with stakeholders across divisions in creating appropriate end-to-end process documentation based off current and future states resulting in business visibility and process improvement
- Analyzed and aligned functional area policies, procedures, SOPs and workflows ensuring compliance and alignment with regulations
- Governed business policy requests across the company while facilitating discussions with stakeholders to capture all pertinent procedural content
- Conducted analysis of business policy requests by researching regulations set by agencies such as CMS, MIA and their intended impact to make effective policy recommendations
- Led risk assessments on identified risks within division to analyze, refine and evaluate process with pertinent regulations
- Developed risk assessment charters and closeout memos once assessment has concluded providing Compliance findings and remediation proposals
- Communicated with internal areas including Health Services, Corporate Audit, Finance & Legal as well as external stakeholders/vendors
- Provided regular investigative, analytic and audit reporting data to stakeholders
- Monitored and controlled corrective action plan implementation and reporting of risks associated with control deficiencies
- Collaborated with Mandates to evaluate and review current regulations, rulings, policies applying to CareFirst lines of business
- Investigated Maryland Insurance Administration (MIA) complaints escalated to CareFirst Executive Inquiry Department
- Managed and facilitated divisional meetings establishing effective and efficient communication determining solutions for risk and control workgroups across the company
Referral Coordinator Manager
Medical Management Billing Compliance, LLC. (MMBC/LLC.)
03.2013 - 10.2021
- Managed 10+ authorization representatives to ensure insurance authorization process is executed accurately and timely
- Maintained and evaluated clinical data capturing and reporting performance metrics and funding trends across national insurances
- Analyzed and evaluated effectiveness of program initiatives by collecting, organizing, and reporting data to stakeholders, executive leadership, and physician staff
- Coordinated, monitored, and analyzed practice due to changing insurance trends and guidelines, including Medicare Local Coverage Determinations (LCD), ensuring optimum process performance and beneficiary approval
- Directed and assessed quality, efficiency, and productivity of authorization staff with national insurance carriers
- Counseled all patients, physicians, and clinical staff of insurance authorization processes and patient case statuses
- Outstanding written communication skills including developing clear and concise memos for senior staff to ensure billing compliance and process improvements
- Reviewed and developed processes to ensure billing compliance in accordance with federal regulations and mandates
- Provided specific domestic and international self-pay treatment quotes for patients that have been denied by their insurance or chose to pay out of pocket for their course of treatment
- Coordinated the development and analysis of information relevant to sensitive program and administrative issues
- Supervised collection of patient data, financial analysis, and evaluation of documentation required by multiple insurance policies to track approval and staff performance
- Lead weekly operations meeting for physicians, clinical staff and operations leadership to confirm all patient statues are being captured and communicated appropriately
- Disseminated insurance carrier's current program guidelines, policies and instructions to clinical staff for authorization approval visibility
- Collaborated with departmental leadership on program developments
- Collected and evaluated documentation requests for insurance audits to include CMS and commercial carriers
Compliance Officer/Office Assistant
University of Maryland Medical Center
10.2009 - 03.2013
- Managed appointment reconciliation to ensure 100% accuracy of all appointments scheduled
- Provided weekly updates to all attending physicians in the department to ensure they were up-to-date with documentation of patients' treatment records; ensure all appointment notes are dictated and filed in the patient's chart prior to the quality assurance close out of the chart
- Lead the weekly reconciliation of all departmental insurance billing
- Managed front desk responsibilities to include scheduling, rescheduling, cancelling and checking in patients for appointments
Health Service Management AF Medical Services (AFMS)
United States Airforce
09.2005 - 09.2009
- Managed the Medical Affirmative Claims (MAC) Program, including collecting funds from patients, law firms and commercial insurance carriers
- Supervised the Third-Party Collection Program, including providing training to other staff members on new or revised forms and processes
- Obtained active-duty service member and dependent's information for data entry in DEERS
- Managed front desk responsibilities
- Managed requests from Tricare, civilian hospitals, legal agencies, insurance companies and billing of appropriate agencies
- Reviewed Permanent Change of Station (PCS) orders for over 1,000 beneficiary medical records and evaluated DEERS data collected for accuracy
- Chosen shift-leader managing civilian personnel
- Ensured timely mail-out of requests for external agencies and personal copies of medical information
- Responsible for retrieval and submission of monthly disclosure metrics for the 3rd Medical Group
- Responsible for the general maintenance of 8,000 medical records while tracking the daily availability and accountability of the records to assure accuracy and security
- Retrieved and filed Outpatient Records (OPR) for clinics and medical records personnel utilizing the Composite Health Care System (CHCS) program
Education
Bachelor of Science - Business Administration
Wayland Baptist University
Plainview, TX11-2013
Skills
- Complex Problem-solving
- Project management
- Auditing processes
- Ethics and compliance
- Project planning
- Pre-authorizations
- HIPAA compliance
- Insurance verification
- Dedicated team player
- Cross-functional teamwork
- Appeals process proficiency
Timeline
Health Insurance Specialist-Project Manager
CMS Innovation Center (CMS-CMMI)
07.2024 - 02.2025
Senior Regulatory Compliance Analyst
CareFirst BlueCross BlueShield
10.2021 - 06.2024
Referral Coordinator Manager
Medical Management Billing Compliance, LLC. (MMBC/LLC.)
03.2013 - 10.2021
Compliance Officer/Office Assistant
University of Maryland Medical Center
10.2009 - 03.2013
Health Service Management AF Medical Services (AFMS)
United States Airforce
09.2005 - 09.2009
Bachelor of Science - Business Administration
Wayland Baptist University
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