Michael Martellacci Email & Phone Number

New York, Ny, Us

Us

Us

• Reporting directly to the Chief Medical Officer, manage the contractual and service relationships between MetroPlus, a 485,000 member Government Programs HMP and over 18,000 participating Hospitals, IPAs, Medical Groups and other servicing providers• Direct and manage a full risk agreement between the plan and its largest hospital system which includes an overall budget of over $800 million covering 250,000 plan members• Responsible for managing and presenting network benchmark analysis across the specific facility risk entities, which includes CRG, Provider Over or Under Spend, Quality Indicators, Marketing and Utilization data.• Implemented and Chair a company-wide Cost Containment Committee, which works to identify and focus on methods of reducing plan costs through Contracting, Medical Management, and other areas. In 2014, estimated cost containment were just over $21 million• Develop Network and Contracting strategy for the Plan, as company expanded to new product lines including Managed Long Term Care, Medicare, Exchange, HARP and Essential Plan• Assist in the development and implementation of appropriate reimbursement methodologies and contractual strategies with Senior Management• Work closely with Legal, Claims, Medical Management, Marketing and Customer Services to achieve organizational goals

Long Island City, Ny, Us

Oversaw the Provider Operations Department which included; Provider Services, Provider Call Center, Vendor Oversight, Credentialing and Contract Configuration UnitDirected oversight of the State-wide network of 25,000 practitioners and 148 Acute Care FacilitiesResponsible for network sufficiency and compliance with regulatory groups which included Federal, State, and Local Government agency requirementsResponsible for all vendor relationships which include; CVS Caremark with annual budget of $36 million; Davis Vision with an annual budget of $4 million; DentaQuest with an annual budget of $46 million; and Rainbow Transportation with an annual budget of over $6 million

Directed and coordinated all facets of provider operations to assure efficiency, cost effectiveness, access to care, and quality service. The managed network consisted of over 85,000 individual practitioners and 400,000 group practitioner, 95,000 ancillary facilities and 4,200 acute care facilities. The operating budget managed was over 10 million dollarsDeveloped and implemented workflows that enabled a large portion of operations to be out-soured which resulted in 400% increase in productivity and 12% increase in accuracy and 82% reduction in operational expenses Responsible for the contracting process for individual practitioners, delegated group arrangements and leased arrangements Managed merger and acquisition projects, which included Choice One Network, Advantage Healthcare, Ethix, Preferred Plan and BC MergisWas responsible for communicating quality standards and controls, implementing productivity standards and efficiency measures

Contracted with Practitioners to provide clients with increased accessibilityCoordinated preparation and distribution of provider communication materialsConducted on-site provider training sessionsDirected all data management and statistical reporting activities essential to union trustees’ determination of effective cost containment operations

Processed all inappropriately rejected COBRA and disability claims.Assisted in preparation of benefit plan communications including summary plan descriptions, summary annual reports, brochures, notices and newslettersPerform claim analysis for internal auditing