Matthew R. Catalano
Optum
Denmark,WI
19
years of professional experience
Work History
Catcher
1 Year 2 Months- Managed operations for efficient catching and processing of corrugated materials.
- Trained new team members on safety protocols and operational procedures.
- Implemented process improvements to enhance workflow efficiency in production line.
- Ensured quality control standards were met throughout catching operations.
Business Analyst – Optum Payment Integrity
3 Years 9 Months- Supporting the Humana line of business for commercial post-payment recovery operations.
- Functioned as interim manager of medical coders in the recovery space. Managed 13 auditors in day-to-day operations. Facilitated all training, onboarding, development and coaching of auditors as well as conducting monthly and yearly performance reviews.
- Handled all external client-facing meetings as well as with internal matrix partners.
- Worked with development and implementation of financial savings goals. Well exceeded expected outcomes of savings over one-year period of time.
Senior Recovery Resolution Analyst – Payment Integrity
1 Year 6 Months- Supporting Molina prepay review team reviewing medical records to determine claim and billing accuracy. Denying claims if medical records do not support what provider is billing for. Increase savings for Molina client by ensuring provider has billed claim accurately according to CMS, NCCI and Molina guidelines.
- Assist with new hire onboarding by job shadowing new hire candidates.
- Work with internal departments that support payment integrity operations.
Recovery Resolution Analyst – Provider Inquiry Resolution Team
5 Years 7 Months- Full time subject matter expert for support, handling and development of recovery resolution representatives with PIRT. Answer and assist with representative questions, escalations and troubleshooting.
- Investigation into issues arising from claims platform adjudication
- Develop/update job aide documents for PIRT
- Develop and train new hires to PIRT Recovery Resolution role
- Worked with various departments within the FWAE/RAVE team with resolution and troubleshooting of medical records reviews, outcomes and claims decisions
- Assisted PRISM representatives in UHC with provider inquiries for medical records reviews
- Assisted Platinum team UHC provider services agents with Optum escalations
- Handling of escalated calls from providers.
- Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
- Act in accord with current legal procedures as it relates to Fraud, Waste, Abuse and Error and federal HIPAA regulations.
Senior Recovery Resolution Representative – Provider Inquiry Resolution Team
1 Year- Assist providers with the status of current prepayment fraud, waste, abuse and error investigations via DETECTS, PICTS, and FCM case systems. Advised providers of the outcome to medical records reviews, status of pending cases and information on how to appeal denied claims.
- Refer unresolved providers grievances to designated departments for further investigation.
- Intake for fraud, waste and abuse TIPS from members to designated fraud investigators.
- Keep records of provider interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
- Act in accord with current legal procedures as it relates to Fraud, Waste, Abuse and Error and federal HIPAA regulations.
Case Development Associate
11 Months- Open legal files for Optum to pursue subrogation against third party insurance companies on behalf of United Health Care and other major health insurance providers.
- Provide customer service on behalf of Optum to patients, plaintiff attorney representatives and insurance companies inquiring on existing subrogation cases.
- Act in accord with current legal procedures as it relates to subrogation law and federal HIPAA regulations.
Food Service Specialist
3 Years 3 Months- The food service specialist is primarily responsible for the preparation and service of food in field or garrison food service operations. Job duties include, but are not limited to:
- Preparing food that is appetizing and nutritious as prescribed by Army recipes. Operation, maintaining and cleaning field kitchen equipment. Job training for a food service specialist requires ten weeks of Basic Combat Training and nine weeks of Advanced Individual Training with on-the-job instructions. Part of this time was spent in the classroom and part in the field, including practice in food preparation.
Customer Relationship Manager
2 Years 10 Months- Plan, develop, and provide training to Discover Card customer service agents on how to effectively handle customer account inquiries.
- Provide staff development programs, using knowledge of the effectiveness of methods such as classroom training, demonstrations, on-the-job training, meetings, conferences, and workshops.
- Resolve escalated customer complaints regarding credit card account by performing activities such as exchanging merchandise, refunding money and adjusting billing statements.
- Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
- Handled reporting for team of 15-18 customer services representatives, including but not limited to coaching, payroll, and development.
Education
B. A. - Liberal Arts
GPA: 3.4 GPA
Skills
Willingness to accept challenges.
Strong coaching and employee development skills.
Strong communication and customer service skills.
Advanced proficiency with medical claims and claims platforms
Adaptable to change
Strong leadership and mentoring skills
Strong problem resolution skills.
Ability to perform well under stress.
Ability to work as a team member.
Timeline
Catcher
Green Bay Packaging
05.2025 - CurrentRead More
Business Analyst – Optum Payment Integrity
Optum
10.2022 - CurrentRead More
Senior Recovery Resolution Analyst – Payment Integrity
Optum
04.2021 - 10.2022Read More
Recovery Resolution Analyst – Provider Inquiry Resolution Team
Optum
09.2015 - 04.2021Read More
Senior Recovery Resolution Representative – Provider Inquiry Resolution Team
Optum
09.2014 - 09.2015Read More
Case Development Associate
Optum
10.2013 - 09.2014Read More
Food Service Specialist
United States Army
06.2010 - 09.2013Read More
Customer Relationship Manager
Discover Card
07.2007 - 05.2010Read More
Liberty University Online
B. A. from Liberal Arts
Read More