Manager Quality Assurance

Mike Metzger

Email: *********@********.***

Address: *** ********* **

City: Smyrna

State: DE

Zip: 19977

Country: USA

Phone: 302-***-****

Skill Level: Director

Salary Range: $75,000

Primary Skills/Experience:

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Educational Background:

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Job History / Details:

Michael R. Metzger

151 Sunnyside Road

Smyrna, DE 19977

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

Home: 302-***-**** Cell: 302-***-****

Experience

I have worked in credentialing and recredentialing coordination and supervision experience since 1994. A variety of company experiences include, working for two different HMOs (CIGNA & Coventry Health Care, formerly Principal Health Care), a CVO (MedArc, Inc. & Credentialing Connection, Inc.), a hospital (Christiana Care Health Systems-Wilmington Hospital, medical staff office) and an application completion and credentialing consulting company(CredPro Services Corp.). Other experience includes twenty-two years of manufacturing management specializing in quality assurance and production control.

Director of Operations, Medical Society of Delaware 2005 to present. This position is one of the most important in the Society operations as it coordinates all activities for physician activities and is the director of two for-profit subsidiaries for the Society: Credentialing Connection, Inc.(CCI); and Health Hub, LLC. This is an upper management position with several staff report to it. I have been in this position since 2005. The Operations section of this position is responsible for the physical condition and maintenance of the building as well as the computerized HVAC system. This position is responsible for negotiating the contracts for all building related items. Part of the duties include coordination of the conference center which affords four conference rooms, an exhibit hall, and a state of the art Audio-Visual Conferencing System. This position is also responsible for all hardware and software of the company and is primary IT support before send the issue to the contracted IT vendor. This section was added in 2006. CCI is a NCQA certified Credentials Verification Organization since 1999. This position has daily oversight and direction of all activities including operations, marketing and negotiations of contracting. This position reports to the Board of Directions of CCI. Health Hub is the IT arm of the society and has promoted electronic advances in the physician office including EHR, IT Services, web design and other backroom operations in the physician practice.

CredPro Services 2003-2005. President and owner of a credentialing application completion service for physician applications to insurance companies. Also, consulting services in how to organize and operate a credentialing department. This company transitioned in the current position at the Medical Society of Delaware.

Manager of Contract Administration 1996-2003.This position at Coventry was responsible for the credentialing activities, delegated credentialing as well as oversight of the delegated providers and other vendor activities. The primary source verification was centralized for the company in 2003, which reduced the actual staff in the Wilmington location. The department was responsible for all credentialing, recredentialing of providers and ancillaries in four states (Delaware, Pennsylvania, New Jersey, and Maryland). This included the acceptance of providers needed in the network, the mailing and receiving of applications, contracts and processing the file through to the credentialing committees and including the execution of the contracts and mailing of the welcome packages to the approved providers.

Reporting and interaction with other departments include, but not limited to direct report to the VP of Network Operations; direct interaction with the Medical Directors, the Director of Health Services, Quality Management Manager, VP of Marketing and staff, Compliance, regulatory agencies and other senior staff.

Duties included, but not limited to: managing the department and making sure that each member has appropriate and ample work; network development to the extent of direction of the areas of need and supporting the network recruiters; manage the maintenance of the credentialing database; direct and coordinate the production of eight different provider directories; managing the plan for credentialing of 14,000 providers; conducting and coordinating all delegated credentialing audits; normal duties of a manager - hiring, firing, evaluations, promotions and reprimands.

Past experiences that can help your company benefit: helped to increase the network of Coventry Health Care of Delaware, Inc. from 1,000 to current status of 14,000, transitioned the former Principal Health Care of the Mid-Atlantic, Inc. into the current provider network, a total of 5,000 providers, including the re-contracting of the entire network; part of the team to include Medicare as a product line; part of the team to include Maryland Medicaid as a product line; member of the NCQA, URAC, state audits and HCFA audit preparation teams, which included being the main person responsible for the audit and being interviewed for credentialing and delegated oversight; have worked in a hospital medical staff credentialing office, have worked for a CVO, and have worked for another HMO as a credentials group leader and recruiting assistant for new physicians. Previous to the health care field, I worked in the steel industry in manufacturing management.

My experience in health care, production, quality control, scheduling and purchasing lends me insight into all aspects of company management. Many times the solution to problems is talking and working together of all parties so the understanding solution can be accomplished. I have worked with this philosophy with my co-workers. I can work in this capacity and look forward to work for a company that can see the future and knows what is needed.

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