Health Insurance Management

Matthew Kaetzel

***** ******* **** **. ************, MD 20886 - 301-***-****

***********@*****.***

Summary

Network Development Executive for Healthcare Provider Contracting with 15

years of experience in the Managed Care field working with several types of

Health Insurance products, many types of insurers and multiple provider

networks. Extensive experience in negotiating rates and contract language

with all types of health care providers and specialized in provider

retention. Intricate in coming up with creative ways to increase company

revenue and improve efficiency.

Professional Experience

MULITPLAN, Rockville, MD 1994 - 2010

(Formerly BCE Emergis, United Payors & United Providers and America's

Health Plan)

PPO NETWORK DEVELOPMENT EXECUTIVE (2001-2010)

. Negotiated numerous contracts with facilities and health systems in

several states for a Preferred Provider Organization (PPO) and Wrap

product in multiple states for a network of over 40 million participants.

. Maintained relationships with facilities including the handling of

escalated claim issues, contract re-negotiations and network education.

. Managed and operated multiple Local Area Networks (LANs) or affiliate

contracts with other networks.

. Helped payor/clients find the best ways to access the multiple networks

and to understand the contract terms and relationships with hospitals,

ancillaries and LANs.

. Trained new hires on contracting procedures and network education.

NETWORK DEVELOPMENT/PROVIDER RELATIONS REP. (1997-2001)

(with United Payors & United Providers, formerly America's Health Plan)

. Contracted healthcare providers, provider networks and PHOs with a

nationwide PPO/POS network of over 200,000 participants

. Resolved provider's issues on a variety of topics including fee schedule

rates, Payor's procedures, claims processing, credentialing, directories

and local area networks

. Assisted large nationwide insurance companies and payor/clients in

contracting potential providers as well as resolving any current claims

issues.

CLAIMS ANALYST/AUDITOR (1994-1997)

(with America's Health Plan)

. Repriced claims according to negotiated rates between the AHP network and

it's contracted healthcare providers

. Audited claims previously repriced by other employees and our

payor/clients

. Trained new employees and payor/clients and was responsible for their

development in claims processing

ADDITIONAL RELEVANT EXPERIENCE

Supervisory and management experience in mailrooms prior to 1994.

Participated on committees to find new revenue streams and more efficient

contracting procedures since 2004.

EDUCATION

Non Degree Community College Courses in Business Management, Sociology and

Microsoft Office (Frederick and Montgomery County Community Colleges, MD)

PROFESSIONAL DEVELOPMENT

Certificate courses in Medical Terminology and many other courses related

to the Managed Healthcare Professional field from The Health Insurance

Association of America (HIAA). Completed numerous supervisory and

management courses, NCQA credentialing courses and contractual writing

skills classes.

TECHNICAL SKILLS

Word, Excel, Access, Outlook, Act, Contractual Redlining.

Matt Kaetzel- 301-***-****

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