Matthew Kaetzel
10208 Crested Iris Dr. Gaithersburg, MD 20886 -   [Send email to request phone number] 26-1304 
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Summary

 Network Development Executive for Healthcare Provider Contracting- Working from
Home Office-  with 15 years of experience in the Managed Care field working.
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. 
Additional knowledge in Microsoft Office and IWorks. Have been working from home
office for 8 years with minimal supervision and high productivity.  Experience in
claims/data entry as well.                                                       
          

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. Worked from home office for over 8 years with MultiPlan
with a high productivity rate and professionalism. 

EDUCATION
Non Degree Community College Courses in Business Management, Sociology and
Microsoft Office (Frederick and Montgomery County Community Colleges, MD).
Microsoft Office courses at CompuServe. 

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 & IWorks.