Leslie Barnes

• Facilitated seamless transitions between different stages of the enrollment process by maintaining open lines of communication among various departments involved in provider services operations.
• Streamlined provider enrollment processes by implementing efficient data management systems.
• Troubleshot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
• Assisted providers with navigating online portal systems, enhancing user experience and expediting application submissions.
• Contacted insurance carriers to obtain information regarding denials.
• Reviewed contracts thoroughly to ensure adherence to organizational policies and guidelines before finalizing provider agreements.
• Consistently met or exceeded departmental performance targets through diligent management of individual workload and effective collaboration with team members.
• Audited provider information regularly to ensure accuracy and completeness of documentation, reducing potential risks associated with noncompliance.
• Maintained up-to-date knowledge on regulatory changes, ensuring compliance in all provider enrollments.
• Implemented quality control measures to identify areas for improvement in the enrollment process, resulting in reduced processing time.
• Prepared and processed provider enrollments with Medicare and Medicaid in multiple states.

Conduct a review of Medicare Part B claims on services that are appealed by a provider.

Render appeal decisions based on research of initial claims process documented procedures and policies.

Respond to appeal request by adjudication to pay, refund or written response.

Respond timely to Medicare inquiries by researching external systems such as Multi-Carrier Systems, Microsoft and Windows applications.

Effectuate QIC (Qualified Independent Contractor) decisions that contain medical terminology and ICD-9 codes.

• Implemented visual merchandising standards to create an appealing store environment, driving customer engagement and sales growth.
• Streamlined store operations for increased efficiency and productivity through effective delegation of tasks.
• Reduced inventory discrepancies by conducting regular audits and implementing improved tracking procedures.
• Led training sessions for new employees, fostering a supportive learning environment that facilitated rapid skill development.
• Collaborated with management on strategic planning initiatives, contributing to overall store success.
• Mentored team members to develop their skills, resulting in multiple promotions within the company.
• Optimized inventory management processes, reducing stock discrepancies and improving product availability for customers.