Lindsay Barnes
Culpeper,Va
Overview
3
3
years of professional experience
1
1
Certification
Work History
NE & SE Regional Clinical and Quality Programs Manager
Agilon Health
09.2023 - Current
- Engaged physician network to assess members, ensuring HEDIS quality gaps data is submitted with CMS compliance
- Developed/improved systems, processes, and tools for care gap identification and market standing documentation
- Leading efforts to analyze market performance for improvement identified through the reports provided such as creating the path to 4 stars document which reflects our cut points and the payers resulting in over all STARs performance, sending FMC Reports, and Lead Indicator Reports
- Working closely with all our payers along with reviewing payer contracts and implementing strategies to meet goals, as a result a market had an overall STARs rating of 3.4 with Aetna and we were able to get them to a 3.8 avoiding any penalties
- Presenting patient experience data along with implementing new strategies for success such as updating patient pamphlets given out in the office, sending out Leadership and Office manager dashboards reflecting successes and growing points, and working with staff to change processes as needed
- Leading efforts to work with the Risk Adjustment and Quality teams to align on capturing an enrollee and/or our markets population’s health status to improve diagnoses, pharmaceutical utilization, and demographics
- Delivering and comprising clear presentations of FMC Measures, board meetings for Patient Experience data and Quality standings, along STARs Performance with markets and colleagues.
SE Regional Program Manager
Agilon Health
04.2022 - 09.2023
- Improved processes such as PMRR Reviewer onboarding by organizing it on Monday.com to have a step by step
- The outcome was faster and more streamlined onboarding
- Improving timelines from 4 weeks down to 2 weeks
- Worked very closely with employees within and external to Agilon along with reviewers/providers to create strategic training to ensure metrics and data are understood while being executed appropriately along with being met for quarterly and end of year goals
- Document and resolve low assessment rate which led to 92% resulting in meeting the mid-year goal
- Created reporting reflecting new changes with V24 vs V28 ICD-10 Coding for provider, coder, and market education
- Keep markets and team updated on project changes or issues and provide details for resolution
- Devised tools and benchmarks to improve team performance and monitor production by training Southeast Region team members in the Risk Adjustment program along with reporting, data program goals and information to accomplish set goals and benchmarks
- Created and conducted team huddles to enhance communication and support.
Claims Specialist
Guardian Life
06.2021 - 03.2022
- Exceeded individual performance metrics by maintaining high call volume and quality assurance scores
- De-escalated caller concerns and provided clear next steps for issue resolution
- Took care of escalated files with significant indemnity exposure and enlisted to supervisors for further investigation if needed.
Reception Coordinator
Carolina Oral and Maxillofacial Surgery Center
12.2020 - 06.2021
- Assisted the O.R tech in the sterilization and set up of procedure rooms
- Improved patient satisfaction scores through active listening, conflict resolution, and problem-solving skills by around 50%
- Processed patients’ medical history, health insurance and payments, handled specialist referrals, and x-rays.
Education
Associates - Biochemistry
Northern Virginia Community College
Bachelor of Science - Cellular Development and Gene Editing
Northern Virginia Community College
Skills
- Performance Improvement
- Effective Communication
- Operational Efficiency
- Leading Growth and Development Efforts
- Time Management
- Conflict Resolution Tactics
- Market/Physician Meetings Facilitation
- Implementation Strategies
- CMS Compliance
- Operational Planning
- Program Development and Planning
- Action Plan Creation
- Patient Care
- Leadership
- Regulatory Compliance
- Risk Adjustment
- Clinical
- Quality
Certification
- 02/2021, Care Credit Certification, Care Credit Course- Online
- In Progress, CRC Risk Adjustment Coding Certification, Risk Adjustment and Hedis Gaps AAPC-Online
Timeline
NE & SE Regional Clinical and Quality Programs Manager
Agilon Health
09.2023 - Current
SE Regional Program Manager
Agilon Health
04.2022 - 09.2023
Claims Specialist
Guardian Life
06.2021 - 03.2022
Reception Coordinator
Carolina Oral and Maxillofacial Surgery Center
12.2020 - 06.2021
Associates - Biochemistry
Northern Virginia Community College
Bachelor of Science - Cellular Development and Gene Editing
Northern Virginia Community College