Jay Scott

Dynamic and results-driven leader with over a decade of experience in Medicaid operations, regulatory compliance and program implementation. Proven ability to lead large-scale initiatives, align operational processes with strategic objectives, and foster partnerships to drive impactful outcomes. Expertise in financial oversight, IT integration, and program design, with a commitment to improving member experiences and ensuring compliance with state and federal regulations. Adept at building and leading cross-functional teams, developing innovative solutions, and delivering measurable results.

ERNST & YOUNG (LOUISIANA MEDICAID PPMO)

Operations and Project Manager

Supported Louisiana Department of Health’s (LDH) Medicaid Enterprise Systems (MES) modernization initiatives as part of Ernst & Young’s government services consulting team. Maintained an operations role while also directly participating in multiple projects.

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Role: Operations Manager    | Start/End: Jan 2023 – Present           

Direct core operational components of PPMO including strategic planning, resource management, budget management, vendor oversight, process design, contract adherence and regulatory compliance, increasing profitability by 23% while maintaining high service quality.

- Oversee $24M budget, including financial planning, reporting, forecasting and invoicing. 

- Coordinate 23-person team, including hiring, onboarding, and performance management.

- Design and implement processes to enhance efficiency and standardization. 

- Monitor adherence to contractual obligations, maintaining alignment with regulatory and quality benchmarks.

- Liaise with LDH Medicaid leadership to drive state goals. 

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Role: Medicaid Systems Project Manager | Start/End: Jan 2023 – Present             

Project: Claims & Encounters Processing, Fiscal & Financial Mgmt and Pharmacy FFS Modules

Lead the procurement of a $300-million Medicaid claims, encounters, financial management and pharmacy system, LDH’s largest technology procurement in 40 years. 

- led project team in defining project goals, developing business requirements, and evaluating vendor solutions to ensure alignment with strategic objectives.

- Collaborated with cross-functional teams including claims operations, encounters processing, financial management, federal reporting, data analytics, TMSIS, TPL, member services, program integrity, and pharmacy to map data flows, systems, and operational processes, ensuring the new solution met business needs.

- Led the analysis of federal regulations and state laws, interpreting legislative requirements and providing strategic recommendations to ensure compliance and operational alignment with policy mandates.

- Optimized project workflows and standardized best practices, implementing process improvements that enhanced efficiency, reduced bottlenecks, and improved overall team productivity.

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Role: Clinical Program Design Lead | Start/End: Aug 2024 – Present         

Project: Cell & Gene Therapy (CGT) Access Model Program

Led a cross-functional team in designing a clinical program and policy framework to support the Louisiana Medicaid’s participation in the CMS CGT Access Model.

- Drafted program description and budget narrative, outlining program objectives, staffing, timelines and cost projections. 

- Led development of reimbursement strategies, managed care alignment policies, and patient support policies to ensure compliance with CMS Model requirements. 

- Drove system readiness planning, ensuring Medicaid systems could accurately adjudicate model drug claims, track outcomes-based rebates, flag eligible members and produce required data reports.

- Partnered with community healthcare providers to design member and provider marketing, education and outreach campaigns.

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Role: Program Manager | Start/End: Aug 2024 – Present    

Project: Provider Enrollment & Data Management

Provide program oversight and strategic leadership for the procurement of Louisiana Medicaid’s Provider Management Module, modernizing the state's provider data and enrollment systems.

- Maintain in-depth knowledge of key provider enrollment processes, such as screening, credentialing, enrollment, file maintenance, revalidation and termination.

- Coach and direct project manager, product owner, and technical lead.

- Develop and execute risk mitigation strategies, proactively identifying and addressing potential challenges.

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Role: Implementation Project Manager | Start/End: Jul 2021 – Dec 2022              

Project: Patient Access and Interoperability (PAI) Final Rule Implementation

Led implementation of an API-based interoperability solution to meet CMS PAI Final Rule requirements, allowing Louisiana Medicaid beneficiaries to access their claims and clinical data through authorized third-party mobile apps. 

- Coordinated data migration efforts, overseeing the extraction, validation, and transformation of patient data from the state’s Fiscal Intermediary’s mainframe into a CMS-compliant API. 

- Oversaw Software Testing Lifecycle (STLC) process, including integration, regression, data validation, penetration and vulnerability testing.

- Collaborated with legal to validate compliance with CMS requirements prior to deployment.

- Supervised vendor activities and performance, validating reports and deliverables to ensure accuracy and adherence to contractual obligations.

- Authored API operational policies and procedures addressing, call center support workflows, data migration policies, operational reporting procedures, etc. 

- Developed and executed communications and marketing plan, increasing member awareness and utilization of the newly available options for accessing their healthcare data. 

Role: Operations Manager    | Start/End: Jul 2016 – Jul 2021           

Department: Care Management (CM)

Led the implementation of care management programs, workflows and systems for new Medicaid markets, establishing processes, policies, staffing models, budgets, and member communications to drive effective program operations.

- Managed portfolio of clinical and IT projects, allocating resources, tracking KPIs, monitoring timelines, coordinating project interdependencies, mitigating risks and addressing issues.

- Led the end-to-end implementation of care management systems, developing requirements, overseeing configuration, conducting testing, resolving defects and delivering end-user training.

- Authored policies and procedures to meet state contractual requirements, securing legal approval and state acceptance.

- Directed contract compliance review team, validating alignment with contractual obligations. 

- Led the design and launch of an enterprise-wide care coordination program, integrating support for housing instability, food insecurity, and other Social Determinants of Health (SDOH).

- Developed and executed marketing campaigns to promote care management programs, including text message outreach, program flyers and health education resources.

- Served as finance lead, overseeing and approving all project budgets across the department. 

- Facilitated the Enterprise CM Governance Committee, driving decision-making on care management policies, system enhancements, and operational improvements.

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Role: Regulatory & Contract Compliance Manager | Start/End: May 2014 – Jun 2016   

Department: Regulatory Services

Directed data integration, implementation, and daily operations of a compliance assessment tool, leading deployment across multiple Medicaid markets, designing aligned business processes and supporting health plans in gathering and validating evidence for state contract compliance.

- Conducted a line-by-line review of state Medicaid contracts, identifying, extracting, and entering contractual obligations into the compliance tracking system.

- Established repeatable processes that streamlined new market implementations, reducing rollout timelines by 50% while maintaining quality.

- Designed and executed a strategic marketing campaign to showcase the value of the software, driving adoption in existing markets and generating leadership buy-in for expansion into new markets.

- Developed and conducted training sessions for health plan and shared services staff on effective use of the tool. 

- Authored processes, SOPs, workflows and manuals to standardize and guide utilization practices.

Bachelor’s Political Science  Aug 2009 – Dec 2012 
Hampton University  Hampton, VA