Mary E. Jones
Home Manager
Colorado Springs
Summary
Home manager with 5+ years of experience in supporting adults with developmental disabilities. Proficient in financial management and legal compliance, leading teams to achieve outstanding service delivery. Certified in medication management and emergency life-saving techniques, maintaining a 99% accuracy rate in claims processing. Dedicated to improving client quality of life and fostering organizational effectiveness.
Overview
21
21
years of professional experience
2
2
Certifications
Work History
Home Manager
Sunnyhill, Inc.
01.2019 - 11.2021
- Facilitated services, programs, and opportunities for 3 adults with developmental disabilities, empowering them to become productive citizens and achieve their personal goals in a residential setting.
- Supervised a dedicated team providing round-the-clock on-call support for 3 adults with medical and developmental disabilities living in a home environment.
- Ensured compliance by staff with legal regulations, policies, procedures, and training while providing high-quality care and guidance to the residents.
- Oversaw the documentation, monitoring, and management of residents' finances in collaboration with Medicare, Medicaid, and State Trusts.
- Maintained consistent and positive communication with guardians, service coordinators, and other service providers, showcasing expertise in the Human Services field focused on disability support.
- Coordinated and scheduled residents for medical, dental, and eye appointments, and provided necessary documentation to state and service coordinators.
- Managed staff schedules to ensure appropriate staffing levels in line with contractual requirements and budgets; effectively coordinated direct care shifts to minimize overtime.
- Certified in medication management and emergency life-saving protocols, overseeing the process of distributing prescription medications to residents with precision.
- Trained, supervised, and documented the performance of all staff within the assigned worksite, conducting 90-day evaluations and annual appraisals.
- Optimized household operations by creating weekly menus, grocery lists, and managing household supply purchases while keeping a thorough inventory of individual personal supplies in accordance with their monthly budgets.
Claims Supervisor
MAGELLAN HEALTH SERVICES
11.2006 - 06.2018
- Guided team of 12 associates concentrating on performance management and coaching for career progression.
- established and recorded procedural guidelines to address account-specific nuances proficiently.
- Executed thorough training on account practices, claims systems (CAPS), and essential documentation requirements for staff.
- Engaged, trained, and led effective team of lead claims processors, claims resolution specialists, and processing specialists.
- Evaluated diverse data reports to enhance performance metrics and optimize operational efficiency.
- Administered claims operations, facilitating timely processing and evaluating personnel performance.
- Directed claims processing activities across various business lines, encompassing commercial employer solutions, Medicare, and Medicaid.
- facilitated key group projects as subject matter expert (sme).
Claims Team Lead
MAGELLAN HEALTH SERVICES
03.2003 - 11.2006
- Analyzed trends and training gaps within team, conducting weekly training sessions and monthly individual coaching
- Facilitated resolution of claims inquiries for team of 16 associates through expert advice.
- Evaluated audit discrepancies to support supervisor in minimizing risks and increasing accuracy.
- Assessed and supervised all audit rebuttals concerning individual processors and accounts, monitoring and documenting follow-up actions for possible adjustments.
Claims Resolution Specialist
MAGELLAN HEALTH SERVICES
11.2002 - 03.2003
- Analyzed claims submitted by customer service for feasible adjustments resulting from incorrect payments or denials while adhering to established procedures and benefit guidelines.
- Pinpointed systemic issues leading to numerous claims requiring modifications for identical errors escalated efficiently to other departments to rectify foundational problems.
- Assessed payment accuracy and denial correctness through thorough reviews of member claims. Identified errors and made necessary adjustments to improve claim outcomes.
- Realized overall financial accuracy rating of 99% and maintained daily production rate above 100%
- functioned as backup for customer service managing calls from members, providers, and account management while guaranteeing complete resolution of claims issues.
Claims Specialist II
MAGELLAN HEALTH SERVICES
05.2001 - 11.2002
- Oversaw claims processing for all care levels and different business lines involving various accounts.
- Categorized claims processing according to urgency and timely response needs of distinct accounts.
- Realized financial accuracy rating of 99% coupled with consistent daily production levels exceeding 100%
Education
High School Diploma - undefined
05-1986
Skills
Business productivity tools
Words per minute
Data input proficiency
Health information coding Expertise in compliance Healthcare privacy regulations
Data analysis
Protocol architecture optimization
Precision-focused mindset
effective organization techniques
Collaboration strategies Team development skills Personal growth methods
Certification
medication management
Timeline
Home Manager - Sunnyhill, Inc.
01.2019 - 11.2021
Claims Supervisor - MAGELLAN HEALTH SERVICES
11.2006 - 06.2018
Claims Team Lead - MAGELLAN HEALTH SERVICES
03.2003 - 11.2006
Claims Resolution Specialist - MAGELLAN HEALTH SERVICES
11.2002 - 03.2003
Claims Specialist II - MAGELLAN HEALTH SERVICES
05.2001 - 11.2002
St Francis Borgia Regional High School - High School Diploma,