Elizabeth A. ScottHome: 636.294.0641 | Cell: 850.549.5430 | eascott04@aol.com

1287 Summer Lynne Drive| O’Fallon, MO 63366

ObjectivesTo be a part of an organization that has a desire to focus on Compliance, establish best practices in their operations and who will use their Compliance team to maintain the highest standards established by CMS.

EducationLindenwood University –St. Charles, MissouriJune 2001| Masters in Business AdministrationJune 1998| Bachelors of Arts in Health Care Management

ExperienceDirector, Medicare Compliance Officer – January 2015 - PresentSenior Compliance Manager, Audit and Training – June 2013 – December 2014eHealth Insurance, Inc. | 440 East Middlefield Road, Mountain View, CA 94043

Manage the Compliance Audit and Training team to ensure eHealth, a Field Marketing Organization (FMO) remains compliant with the regulatory requirements established for a broker. Responsibilities include: Ensuring all Compliance policies and procedures are updated annually or as a regulation is updated through

CMS. Establishing Compliance training – annually for Compliance Program and Fraud, Waste and Abuse and as

regulatory requirements is changed for all other training effecting FMO operations. Performing compliance related audits by operational unit to ensure those departments are compliant with

regulat ory requirements. Establishing Corrective Action Plans (CAPs) for those areas that are non-compliant with the regulations.

Compliance Manager– May 2012 – June 2013Essence Health Care | 13900 Riverport Drive, Maryland Heights, MO 63043

Managed a team of three Compliance Specialists whose responsibilities included: Responding to any non-Compliance reported issue including hotline reports. Establishing a venue to impart knowledge to all employees on changes issued through HPMS memos. Work with all departments to correct any deficiencies found through compliance audits. Established a working process for all data validation audits performed by an outside vendor. Established key indicator reporting / monitoring for compliance activities. Coordinated submissions of all marketing materials through HPMS for CMS approval

Compliance Director – September 2009 - May 2012Molina Healthcare of Missouri | 12400 Olive Blvd., St. Louis, MO 63141

Ensured Molina Healthcare of Missouri remained compliant with Missouri Medicaid regulations as well as Missouri insurance regulations. Achievements and responsibilities included: Establishing an internal audit process for the health plan for each department to ensure compliance with

the MO HealthNet contract and state and federal regulations. Guiding the Compliance Committee to ensure comprehensive oversight is provided to all areas of the health

plan. Overseeing completion of any corrective action plan that is established for the health plan. The corrective

action plans could have resulted from audits performed internally or externally. Ensure all fraud, waste and abuse functions are implemented according to, not only the health plan’s

program, but the corporate program as well.

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Ensure the Compliance Hotline was monitored daily and any issues investigated and resolved in a timely manner.

Senior Manager, Medicare Compliance & Audit – December 2008 - September 2009WellCare (Comprehensive Health Management, Inc.) | 8735 Henderson Road, Tampa, FL 33634

Ensured WellCare Health Plans established an internal audit function to instill compliant operational processes. Achievements and responsibilities included: Establishing roles and responsibilities for the internal audit division within WellCare. Working with a team of three individuals whose focus was on internal audit functions for the Coordinated

Care Plans for WellCare. Coordinated audit activities with both internal auditors and external consultants. Established business owner meetings to develop a partnership between the Compliance area and the

operational departments within the organization. Developed standard reporting for audit activities. Served as a member of the team that filed a compliance package with CMS, working towards moving

WellCare out of Intermediate Sanctions.

Internal Audit / Project Compliance Coordinator, PMO – August 2007 - December 2008 Universal American Corp. | 411 Baylen Street, Pensacola, FL

Began tenure with Universal American in the Internal Audit division building a new layer of compliance within the organization by establishing an internal compliance related auditing program to ensure that key operational areas were CMS audit ready. From there, moved to a compliance related role within the Project Management department to ensure there was a focus for all new projects on compliance. Performed analysis of all new regulations published related to Medicare products as well as providing updates to CMS manuals for all project managers.

Quality Management, Compliance Supervisor – February 2003 – July 2007Mercy Health Plans, Inc. | 14528 South Outer Forty Road, Chesterfield, MO 63017

Implemented business processes and work plans to ensure that the health plan received accreditation through URAC for Health Plan, Utilization Management, Case Management and Consumer Protection.

Implemented and coordinated the efforts which allowed the Plan to receive a score of 100% and full-accreditation for Disease Management through URAC in November 2006.

Oversaw and performed audits of operational processes and delegated entities to ensure compliance and to increase compliance and accreditation readiness.

Analyzed operational reports to allow senior level management easy decisions for interventions in quality activities.

Provided leadership and coaching for individuals within the Quality Department

Compliance Manager – October 2001 – January 2003BJC – Care Partners | 120 South Central, 8th Floor, Clayton, MO 63105

Directed Care Partners in Medicaid, HIPAA and NCQA compliance activities which included: Developing and performing audits of each reporting area to ensure that Care Partners had all business

areas ready for state and federal audits. Developing and implementing training programs for all Care Partners employees to increase their

knowledge of Medicaid regulatory requirements. Serving as liaison between the Plan, state and federal contacts for approval processes, member issues and

regulatory updates. Developing and implementing a HIPAA work plan in conjunction with the corporate office. Developed and

implemented training on pertinent HIPAA policies and procedures.

Regulatory Compliance Manager – April 2000 – June 2001Manager, Enrollment and Compliance – August 1996 – April 2000

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Policy and Compliance Analyst – July 1995 – August 1996 Group Health Plan (Coventry) | 111 Corporate Office Drive, Earth City, MO 63045

Directed GHP in Medicare+Choice compliance activities while managing two departmental lines and a staff that ranged from 18 to 11 individuals. Additional duties included:

Served as co-chair for the Compliance Committee made up of Directors and Vice Presidents of GHP. This committee served as a steering Committee to ensure that GHP was compliant with the federal and state regulatory requirements.

Performed audits throughout the year of each reporting area to ensure GHP was ready for bi-annual Medicare audits. Results were demonstrated with the last audit conducted resulting in zero findings and five notes – the most favorable audit in the history of GHP.

Developed and implemented a training program for all GHP employees to increase their knowledge of Medicare regulatory requirements.

Served as liaison between the Plan and Medicare for approval processes, member issues, and regulatory updates.

Assisted in gathering and developing information for establishing a work plan to implement the Health Insurance Portability and Accountability Act (HIPAA) required by all industries to ensure privacy for their customer base.

The enrollment department served as a clearinghouse for 500 to 1000 new enrollees each month. The staff of ten (10) ensured applicants wanting to obtain health care coverage through GHP was enrolled with the effective date requested. At the same time, this staff ensured that premium payment reconciliation was taking place and that the plan was receiving the over $18 million payment each month.

The Compliance department contained one Compliance analyst/auditor. This individual assisted in ensuring all areas of GHP were in compliance with Federal and State regulators, served as a liaison between GHP and Medicare, oversaw on-site reviews as well as conducted periodic internal audits.

Managed the Appeals and Grievance unit through August 1999 when the unit was incorporated into the Member Service department. This unit was staffed with two appeals coordinators and one supervisor whose role was to ensure that all members received an equal opportunity for hearing on complaints and appeals through research of claims and committee hearings.

Compliance Specialist – August 1992 - June 1995 Physicians Health Plan (United Healthcare) | Riverport Drive, Earth City, MO 63043

Began tenure as the Administrative Assistant to the Director of Government/Special Projects with work assignments that included developing and maintaining working relationship with the Health Care Financing Administration (HCFA, now known as CMS) with regards to Medicare products, member appeals procedures and product advertising. In addition, developed service area expansion applications for submission to HCFA.

Administrative Assistant –Foreign Service – January 1990 – April 1992US Department of State Foreign Service Administration | Washington DCBegan training for a Foreign Service employment tour with the United State Department of State in Washington, DC for four months. The initial four months served as a work and educational assignment. Assignment began as a Foreign Service Administrative Assistant in Managua, Nicaragua within the Security Offices of the U.S. Embassy. This position provided assistance to both military and government personnel. The assignment required a top-secret security clearance as well as additional clearance based on additional assignment.

Professional Organizations Health Care Compliance Association (HCCA) Society of Corporate Compliance and Ethics