Mary Lou Jones
Albuquerque,United States
Summary
Skilled professional with strong medical as well as human resources and operations background. Skilled in working under pressure and adapting to new situations and challenges to best achieve company goals.
Overview
47
47
years of professional experience
1
1
Certification
Work History
Practice Manager
Urology Group Of New Mexico, P.C.
Albuquerque, NM
10.2007 - 02.2022
- Manage team of employees, overseeing hiring, training and professional growth of employees.
- Monitor company inventory to keep all medical and office supplies stocked and handle the purchasing.
- Proven successful working within tight deadlines and fast-paced atmosphere.
- Prepare variety of different written communications, reports and documents.
- Enroll and revalidate doctors and facility with insurance companies and hospitals.
- Process applications for licensing, permits, certifications, insurances and relevant credentialing documents.
- Responsible for the operations, personnel, and financial management of the practice.
- Negotiate contracts with payors and vendors.
- Billing and Coding of all office visits and hospital surgeries.
- Manage all accounts receivables for insurance and patient accounts.
- Appeal all insurance denials.
- Prepare accounts payable, payroll and accounting items monthly to the Accountant.
- Implement new practice management system, telehealth system, and new phone system.
Clinical Research Coordinator
Urology Group Of New Mexico, P.C.
Albuquerque, NM
02.2005 - 10.2007
- Screen and evaluate candidates for clinical research studies.
- Recruit study participants and conduct informed consent.
- Maintain required regulatory documents.
- Perform clinical tasks such as blood draws, post void bladder scans, vital signs and ECGs.
Medical Appeals Specialist
Lovelace Health Plan
Albuquerque, NM
06.1998 - 02.2005
- Review medical denials against medical policies and the patient medical record, make recommendation and submit to the Medical Director for approval or denial.
- Write approval or denial letter to the patient.
- Coordinate the Level II appeal review with independent reviewers and present appeal.
- Write approval or denial letter to the patient.
- Help with preparation of NCQA and Medicare audits.
Enrollment/Customer Service Agent
Health NM
Albuquerque, NM
09.1997 - 06.2008
- Enroll new members to Health NM.
- Offer friendly and efficient service to customers, handle challenging situations with ease.
- Actively listen to customers' requests, confirming full understanding before addressing concerns.
Licensed Insurance Agent
State Farm
Albuquerque, NM
03.1995 - 08.1997
- Present and sell insurance policies to new and existing clients.
- Develop and calculate suitable plans based on client's needs.
- Resolve client inquiries and complaints.
- Submit auto and home claims to claims department.
- Solicit for new business via telephone, referrals, networking and lead databases.
Executive Assistant
Continental Airlines
Albuquerque, NM
06.1985 - 03.1995
- Perform varied administrative duties requiring judgement inititiave and a knowledge of the functions to support the managerial unit.
- Schedule appointments and make arrangements for meetings and conferences.
- Dictation of General Manager correspondence.
- Maintain professionalism and strict confidentiality with all materials and communications.
- Audit of all ticket sales.
- Accounts payable and coding.
- Assist with airline gate agent activities.
- Plan annual Christmas party for the New Mexico Office.
Education
Psychology
University of New Mexico
Albuquerque, NMAssociate of Arts - Business Administration
National American University
Albuquerque, NM05.1985
Skills
- Operating Plans Development
- Decision Making
- Verbal and Written Communication
- Data Analysis
- Critical Thinking
- Epic Systems
- Employee Performance Evaluations
- Codes Compliance
- Human Resources Management
- Health Information Systems
- HIPAA Guidelines
- Medical Coding, Appeals, and Prior Authorizations
Certification
Urology Coding Certification
Health, Property & Casualty, Auto, and Life Insurance
Studying for CPC Certification
Languages
Spanish
Native or Bilingual
Timeline
Practice Manager
Urology Group Of New Mexico, P.C.
10.2007 - 02.2022
Clinical Research Coordinator
Urology Group Of New Mexico, P.C.
02.2005 - 10.2007
Medical Appeals Specialist
Lovelace Health Plan
06.1998 - 02.2005
Enrollment/Customer Service Agent
Health NM
09.1997 - 06.2008
Licensed Insurance Agent
State Farm
03.1995 - 08.1997
Executive Assistant
Continental Airlines
06.1985 - 03.1995
Psychology
University of New Mexico
Associate of Arts - Business Administration
National American University
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