Manager Service

MARY R. LAWLOR

***** ********* ***** *:

301-***-****

Silver Spring, Maryland 20905

**********@***.***

C: (301)919-

3696

EXPERIENCE: Reimbursement Case Advocate/Appeal Representative

**** - 2014

The Lash Group, Rockville, MD

. Provided a comprehensive reimbursement resource for

patients, physicians, and specialty pharmacy for complex

therapy.

. Coordinated required clinical documentations with the

physician and health insurance to maximize reimbursement

via Prior Authorization Approvals.

. Achieved a customer-service bonus within two months of

employment. Territories consisted of New England and New

York.

Director of Admissions

2006 - 2008

HRC Manor Care Health Care Services, Silver

Spring, MD

. Building and growing patient census with quality mix of

short and long-term patients by developing the market and

prospective residents with appropriate information and

assistance to choosing the nursing center. Created

marketing brochures for sale calls, and implemented an

electronic clinical e-mail connection with various

hospitals, called e-Discharge, to better service clients

with placement issues.

. Audited clinical records, and knowledgeable of skilled

nursing facility Medicare and Medicaid benefits.

. Achieved an increase in census from 75% to 90% in six-

months and 99% in a year.

Contract Implementation Manager

1998 - 2006

CIGNA Healthcare of Mid-Atlantic, Inc.,

Columbia, MD

. Led the implementation for MedSolutions to process and

authorize MRI, CT scans and PET scans for 107 outpatient

radiology centers.

. Developed system strategic guidelines to implement the

Maryland Hospital funding Project assisting in reducing

reimbursement to hospitals in Maryland.

Vendor Services Manager

. Managed and developed a Health Service Network consisting

of 16 medical-surgical physician specialties.

Responsibilities include developing Third-Party

Administrator (TPA) contracts, service level agreements,

coordinate electronic data interface between the

Healthplan and TPA, and troubleshoot complex contractual

services and implemented prompt and effective solutions.

ADDITIONAL EXPERIENCE

National Network Development Administrator

Coventry Healthcare, Inc. (formerly known as Principal Health Care)

Bethesda, MD

. Negotiated contracts with strategically located hospitals

for participation under HMO and PPO plans for the

territories of Chicago and Tampa Bay.

Medical Personnel Placement Consultant

Medical Personnel Service, Inc, Silver Spring, MD

Clinical Practice Manager

The Johns Hopkins University, School of Medicine,

Baltimore, MD

. Supervised and administered a $24M accounts receivable for

the rendering of health care services by two hundred (200)

faculty physicians of a multi-specialty academic

department.

. Created, marketed, promoted and managed the health care

screening service titled, "Executive Health Program".

Instrumental in recruiting major corporations as clients.

. Handled a major accounts receivable software system

conversion, resulting in a more integrated method of

conducting business through a user-friendly system.

EDUCATION: University of Maryland University College, College Park

B.S in Business Management - Emphasis

on Anatomy & Physiology and Medical Terminology

Computer Skills: Windows XP, Word, Excel, Power

Point, IDX Billing System and Facility & Ancillary

Contract implementation application

PMHS and Proclaim

ADDITIONAL INFORMATION:

. CIGNA HealthCare Circle of Excellence Award

. Johns Hopkins Medicine Employee Award

Contact this candidate