Scott Banken, CPA

Scott Banken brings 29 years of experience as a certified public accountant with 20 years focused on health insurance, Medicaid and value-based reimbursement.

Prior to joining FTI Consulting, Mr. Banken consulted with several state governments as a Principle with Mercer Government on the oversight of their Medicaid managed care plans to ensure compliance with federal regulations and efficiently utilize reporting from managed care plans for oversight and regulatory reporting. Prior to joining Mercer, Mr. Banken also managed finance and accounting teams in both national and regional Managed Care Organizations, concentrating in government programs. This experience allows him to understand different strategies for financial management Medicare and Medicaid programs including capitation rate plans, risk sharing and risk corridor negotiation, benefit management and interventions to maximize efficiency and minimize costs.

Mr. Banken works with clients on designing innovative programs that use financial data to drive improvements to the quality, customer satisfaction and efficiency of their Medicaid programs, including their management information systems. He also brings expertise in financial oversight plan design and financial systems development to create efficient, auditable reporting solutions for financial, regulatory and operational reporting that fosters communication through entire organizations. His expertise in Medicare and Medicaid cost principles allowed him to develop templates for cost-based rates, including the template used for Certified Community Behavioral Health Clinics in the current demonstration.

Mr. Banken holds an accounting degree from the University of St. Thomas and an M.B.A. from University of Minnesota’s Carlson School of Management. He is a Certified Public Accountant, licensed in Minnesota, and a member of the MN Society of Certified Public Accountants.

Relevant Experience:

• Created performance management reporting systems for financial oversight of MCOs. Created financial oversight programs to help states monitoring Medicaid MCOs key financial metrics to track profitability, solvency and efficiency. Analyzing financial results for MCOs for accuracy and reasonableness.
• Developed cost report templates, instructions and technical assistance webinars for prospective payment system rate development for Certified Community Behavioral Health Centers. Identified performance metrics and criteria to evaluate cost report submissions for completeness and accuracy.
• Negotiated value-based contracts with providers around Medicaid and Dual-Eligible member programs to improve levels of care and manage risk, including fee-for-service (FFS), per member per-month capitation, quality bonus payments, risk-sharing and shared savings. Facilitated multi-payer workgroups to build consensus and develop alternatives to FFS that incent outcomes rather than volume for state innovation model grant recipients.