Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Lindsay R. Barnes

Culpeper,Va

Summary

Creative Senior Program Manager with exceptional background in the Risk Adjustment BOI industry. Proven success building and motivating program teams to meet project goals. Demonstrated leadership in systems implementation, program execution and process improvement engagements with a history of dedicated and motivated professional experience looking to contribute superior patient service, problem solving, and program management skills to a challenging new position. Analytical, calm under pressure, and focused on continuous improvement.

Overview

13
13
years of professional experience

Work History

Regional Program Manager

Agilon Health
04.2022 - Current
  • In this role responsibilities are managing and overseeing end to end execution of Risk Adjustment Program in S.E Region Markets being North and South Carolina.
  • I partner closely with provider network managers and clinical leadership in engaging the physician network to assess members for their significant and chronic diseases as well as ensuring HEDIS quality gaps data is appropriately submitted.
  • I work across multiple operations teams to develop or improve systems, processes, and tools that will help with the identification of diseases, assessment of diseases, and care gaps with proper documentation to ensure accurate submission of information to market entities. One example of a process that I have changed is PMRR Reviewer onboarding organizing it on Monday.com to have a step by step and the outcome was faster and more streamlined onboarding. improving timelines from 4 weeks down to 2 weeks.
  • I help reviewers gain access to systems while make sure appropriate documentation is signed and added to Monday.com such as confidentiality agreements and Reviewer agreements and I also schedule new provider training along with emailing the PMRR Reviewer guidelines and expectations
  • Adept with developing tactics to meet program goals and metrics.
  • I work 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.
  • I assist and lead in obtaining access for providers, data needs, and researching data issues with deep dives.
  • I perform daily data entry, report generation, and tracking of metrics as requested for all markets.
  • I supply PMRR feedback for reviewers in all markets showing whether or not the physician agrees or disagrees with suggestions from the reviewer and use that to present educational growth for the PMRR Reviewers while working closely with clinical leadership.
  • I have lead efforts to analyze market performance for improvement identified through reports I provide.
  • Being point of contact for issues/ concerns for team and experienced market providers including POD Leaders and Reviewers.
  • I am also responsible for training the team and markets on valuable information and implementation.
  • I created team huddles for our team bi-weekly to discuss any information, updates, strategies, and offer assistance. During these team huddles I have also been leading personality assessments and icebreakers so we can learn our team members and how to best utilize our strengths and be aware of our weakness so we can work on those and grow for not only our markets success but for our team as well.
  • Each month I submit reviewer timesheets/ invoices while also following up to make sure their hours and submissions for training, charts, and case studies have been entered correctly
  • I send out monthly case studies that are Agilon compliant to markets for review then collecting that data for the following markets PMRR meetings for clinical education.
  • Helping closely with the creation of PMRR and POD Leader decks and agenda items.
  • I work closely with the SE Region Director and collaborate with physician partners and team members to drive BOI performance, resulting in an overall assessment rate of 92% while identifying strategies and best practices for market improvement.
  • Been working on implementing a standardization of reports across the region such as providing Scorecards which include POD, Provider, and location summaries along with Patient Rosters for the markets in the S.E Region along with any reports needed for the markets
  • Currently I am working on my CRC certification so I am able to help in more clinical discussions and increasing knowledge.
  • Engaged with customers, partners and constituent groups to create positive, trusting and professional relationships.
  • Kept markets and team updated on project changes or issues and provided details for resolution.
  • Met tight deadlines to satisfy client demands and project timelines.
  • Delivered clear presentations of metrics, reviewer responsibilities, and case study responsibilities during meetings with markets and colleague's, using effective public speaking skills.
  • 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.

Claims Specialist

Guardian Life
06.2021 - 03.2022
  • I resolved customer inquiries related to Life Insurance coverage, while ensuring that I deliver excellent customer service.
  • I also research premium or loan payment related matters, assisting clients with making policy changes including updates to address of record, listed beneficiaries, while recognizing when the client should consult with their financial professional for further guidance.
  • Meet and exceed individual performance metrics including average calls per day, adhering to daily schedule, Quality Assurance call scores, client survey scores, etc.
  • Properly verify callers by obtaining correct data points or Personally Identifiable Information (PII) to ensure information is provided to the appropriate party.
  • Successfully navigate multiple computer systems while simultaneously ensuring the call flow with the customer continues to occur.
  • De-escalate caller concerns and set clear expectations of next steps that will need to occur to resolve an inquiry.
  • Thoroughly document the particulars of a call in a timely manner within a tracking system.
  • As well as being extremely empathetic, diligent, and very detail oriented.
  • Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
  • Followed up with customers on unresolved issues.
  • Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
  • Performed administrative duties by verifying documentation, researching facts, and contacting other parties involved to determine fault percentages and minimize potential losses.
  • Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
  • Escalated files with significant indemnity exposure to supervisor for further investigation.
  • Negotiated with other involved parties to arrange settlements for maximum results.
  • Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
  • Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
  • Checked documentation for accuracy and validity on updated systems.
  • Utilized appropriate cost containment techniques to reduce overall claim costs.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Posted payments to accounts and maintained records.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Processed and recorded new policies and claims.
  • Verified client information by analyzing existing evidence on file.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.

Reception Coordinator

Carolina Oral and Maxillofacial Surgery Center
12.2020 - 06.2021
  • Responsibilities include; overseeing patient records, communicating to our team for the best patient care, scanning in documents, planning for surgeries by gathering health history such as PMP’s (a system which helps to promote the appropriate use of pain relieving drugs by preventing their diversion, abuse, or misuse to each patient before surgery), referrals from general dentist offices/ orthodontist, and inputting X-rays into a system for surgeries and patient record, handling payments, confirming appointments as well as scheduling them, following up with patients’ for Pre-operative appointments, and calling other general dental practitioners for information regarding patients to set them up for their appointments.
  • Very organized, have great time management, clear and concise with words while assisting patients on the phone, when they come into your office, presenting them with their treatment solutions, to the time they leave.
  • I am always be professional to the utmost while being empathetic to their care and treatment.
  • I would take and put insurances into a patients’ record so that the insurance coordinator can process and file patients’ insurance
  • I have HIPAA and OSHA training up to date as well as a CareCredit certification.
  • Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
  • Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff.
  • Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
  • Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
  • Implemented project management techniques to overcome obstacles and increase team productivity.
  • Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
  • Monitored front areas so that questions could be promptly addressed.
  • Kept high average of performance evaluations.
  • Managed supervisor itinerary and appointments and streamlined scheduling procedures.

Shift Supervisor/ Manager

Starbucks
01.2019 - 02.2020
  • Responsibilities include overseeing employees and communicating with the regional and corporate offices.
  • Ensure all operations adhere to the guidelines set forth by the company. Managed end to end daily operations.
  • Developing new ways to improve customer service and increase sales within the store.
  • Worked with corporate to create new promotions and initiatives to attract more customers and finding ways to better engage existing customers within the Starbucks communities such as Pride, Hispanic communities, and many more.
  • I was in charge of managing inventory by ordering supplies, doing audits so we are decreasing waste along with coming up with bogos and such to increase popularity of other items that are not as popular
  • Managed and motivated employees to be productive and engaged in work.
  • Accomplished multiple tasks within established timeframes.
  • Maintained professional, organized, and safe environment for employees and patrons.
  • Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
  • Cross-trained existing employees to maximize team agility and performance.
  • Maximized performance by monitoring daily activities and mentoring team members.
  • Onboarded new employees with training and new hire documentation.
  • Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
  • Communicated clearly with employees, suppliers and stakeholders to keep everyone on same page and working toward established business goals.
  • Controlled costs to keep business operating within budget and increase profits.
  • Developed and maintained relationships with customers and suppliers through account development.
  • Improved safety procedures to create safe working conditions for workers.
  • Developed and implemented business strategies to achieve business goals and stay competitive.
  • Improved marketing to attract new customers and promote business.
  • Planned and budgeted accurately to provide business with resources needed to operate smoothly.
  • Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
  • Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
  • Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
  • Established team priorities, maintained schedules and monitored performance.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
  • Assisted in organizing and overseeing assignments to drive operational excellence.
  • Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
  • Defined clear targets and objectives and communicated to other team members.
  • Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
  • Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
  • Established performance goals for employees and provided feedback on methods for reaching those milestones.
  • Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
  • Successfully managed budgets and allocated resources to maximize productivity and profitability.
  • Identified and communicated customer needs to supply chain capacity and quality teams.
  • Set aggressive targets for employees to drive company success and strengthen motivation.
  • Developed detailed plans based on broad guidance and direction.
  • Reduced waste and pursued revenue development strategies to keep department aligned with sales and profit targets.
  • Controlled resources and assets for department activities to comply with industry standards and government regulations.
  • Leveraged data and analytics to make informed decisions and drive business improvements.
  • Launched quality assurance practices for each phase of development
  • Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.
  • Streamlined and monitored quality programs to alleviate overdue compliance activities.
  • In charge of scheduling employees while adhering to their schedules supporting what employees need for a great work life balance.
  • Adhering to company policies, procedures, and standards and making sure my team was also doing so.


Receptionist

Elite Shooting Sports
10.2018 - 06.2019
  • In this position, I performed a variety of duties including greeting and adding first time shooters to our database as well as checking for valid government issued identification such as a driver’s license, passports, and permits.
  • We have worked with a variety of government agencies along with the military and the general public.
  • We are responsible for carrying out policies, rules, and regulations on the range and in the lobby, signing up customers, cleaning tasks, knowing how to use the AIMSI system, and putting anyone and everyone that was new into the safety video.
  • Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
  • Confirmed appointments, communicated with clients, and updated client records.
  • Kept reception area clean and neat to give visitors positive first impression.
  • Answered phone promptly and directed incoming calls to correct offices.
  • Responded to inquiries from callers seeking information.
  • Resolved customer problems and complaints.
  • Corresponded with clients through email, telephone, or postal mail.
  • Handled cash transactions and maintained sales and payments records accurately.
  • Managed multiple tasks and met time-sensitive deadlines.
  • Maintained confidentiality of information regarding clients and company.
  • Answered central telephone system and directed calls accordingly.
  • Provided clerical support to company employees by copying, faxing, and filing documents.
  • Restocked supplies and submitted purchase orders to maintain stock levels.
  • Assisted with onboarding new clients and securing paperwork completion.
  • Welcomed customers with friendly greeting, answered general questions, gathered nature of visit and directed to specific offices.
  • Organized, maintained and updated information in computer databases.
  • Answered questions and addressed, resolved, or escalated issues to management personnel to satisfy customers.
  • Operated multi-line telephone system to answer and direct high volume of calls.
  • Handled assignments independently with good judgement and critical thinking skills.
  • Assisted internal staff with clerical and administrative needs to maximize efficiency and team productivity.
  • Routed incoming mail and messages to relevant personnel without delay.
  • Collected and distributed messages to team members and managers to support open communication and high customer service.
  • Collected late/ delinquent payments, processed transactions and updated relevant records.
  • Scheduled office meetings and client appointments for staff teams.
  • Handled incoming and outgoing package deliveries, working with vendors to complete special requests and track missing packages.
  • Helped office staff prepare reports and presentations for internal or client-related use.

Apparel Coordinator / Cashier

Dicks Sporting Goods
04.2012 - 03.2014
  • In this position, I assisted in the store management team with overall general supervision in my assigned department while also helping and supporting other departments as needed
  • Greeted customers entering store and responded promptly to customer needs.
  • Built relationships with customers to encourage repeat business.
  • Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
  • Worked flexible schedule and extra shifts to meet business needs.
  • Welcomed customers and helped determine their needs.
  • Helped customers complete purchases, locate items, and join reward programs.
  • Restocked and organized merchandise in front lanes.
  • Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
  • Stocked, tagged and displayed merchandise as required.
  • Assisted customers with returns, refunds and resolving transaction issues.
  • Answered questions about store policies and addressed customer concerns.
  • Worked closely with shift manager to solve problems and handle customer concerns.
  • Addressed customer needs and made product recommendations to increase sales.
  • Tallied cash drawer at beginning and end of each work shift.
  • Upsold additional products and services to customers, increasing revenue.
  • Performed cash, card and check transactions to complete customer purchases.
  • Operated cash register to record transactions accurately and efficiently.
  • Handled cash with high accuracy and took care to check bills for fraud.
  • Learned duties for various positions and provided backup at key times.
  • Used POS system to enter orders, process payments and issue receipts.
  • Worked with floor team and managers to meet wide range of customer needs.
  • Maintained current knowledge of store promotions and highlighted sales to customers.
  • Responded promptly to requests for assistance, spills and customer inquiries.
  • Processed refunds and exchanges in accordance with company policy.
  • Reconciled cash drawer at start and end of each shift, accounting for errors, and resolving discrepancies.
  • Encouraged customers to make additional purchases by highlighting current deals and keeping lane well-stocked.
  • Checked personal identifications during alcohol and tobacco sales.
  • Kept cash wrap stocked, products faced and shelving free of misplaced items or trash.
  • Set up new sales displays each week with fresh merchandise.
  • Conducted inventory counts by adding each item in stock and documenting in computer system.
  • Monitored self-checkout systems and provided help in resolving complex problems.
  • Demonstrated product features, answered questions and redirected objections to highlight positive aspects.
  • Helped customers navigate applications and in-store technology to deliver best-in-class experiences.
  • Identified and resolved discrepancies and errors in customer accounts.

Apparel Lead

Sports Authority
10.2011 - 04.2012
  • Followed company work processes to receive, open and unpack boxes, cartons and totes, stock merchandise, restock and rotate merchandise on shelves and build merchandise displays.
  • Assisted in implementation and maintenance of planograms.
  • Provided superior customer service leadership by greeting and assisting customers.
  • Operated cash register and scanner to itemize and total customers' purchases, collect payment from customers and make change and bag merchandise.
  • Opened and closed store under specific direction of store manager.
  • Stocked merchandise, clearly labeling items, and arranging according to size or color.
  • Answered customer questions about products and services, helped locate merchandise, and promoted key items.
  • Engaged in friendly conversation with customer to better uncover individual needs.
  • Listened to customer needs and desires to identify and recommend optimal products.
  • Managed efficient cash register operations.
  • Opened, shelved and merchandised new products in visually appealing and organized displays for optimal sales promotions.
  • Built customer loyalty and retention by delivering excellent shopping experiences.
  • Created inviting environment for customers by maintaining store organization and cleanliness.
  • Delivered energetic responses to customers in-store and by telephone, going above and beyond to serve needs.
  • Volunteered for extra shifts during holidays and other busy periods to alleviate staffing shortages.
  • Provided exceptional services and pleasant shopping experiences to retail customers.
  • Developed strong rapport with customers and created positive impression of business.
  • Maintained up-to-date knowledge of store sales, payment policies and security standards.
  • Used in-store system to locate inventory and place special orders for customers.
  • Prioritized helping customers over completing other routine tasks in store.
  • Recommended complementary purchases to customers, increasing revenue.
  • Monitored customers for signs of security concerns and escalated issues to management.
  • Worked to meet or exceed special targets for credit card applications, special donations and specific product promotions.
  • Conducted product demonstrations to highlight features and redirect objections to positive aspects.


Nanny

Don and Beth Salvaggio
01.2011 - 11.2011
  • Prepared meals and snacks for children based on dietary guidelines.
  • Assisted with light housekeeping duties as well as running errands.
  • Organized and cleaned home after activities by picking up toys and straightening up play room.
  • Built positive and nurturing environments to support child social and emotional growth.
  • Supported children in play activities, meals, and snacks, hygiene and socialization.
  • Monitored schedules to maintain sleeping, eating, and school schedules for children.
  • Bathed, dressed, and helped with teeth brushing as part of bedtime preparation.
  • Played games, worked on puzzles, and read books to young children.
  • Balanced playtime and limited screen time to support development of fine motor, gross motor, and cognitive skills.
  • Established lasting, professional connections with families and children by encouraging open communication and delivering positive feedback.
  • Engaged with children on age-appropriate level.
  • Assisted children with homework assignments and special projects across different subjects.
  • Administered basic first-aid and medication in emergency situations.
  • Developed and implemented behavior management strategies to minimize indiscipline and guide children in attaining positive behavior.
  • Organized extracurricular schedules for sports and classes and provided safe transportation to different events.
  • Taught children basic life skills, manners and personal hygiene.
  • Monitored children's play activities to verify safety.
  • Established and maintained safe play environment for children.
  • Engaged with children on individual basis to build positive relationships.
  • Transported children to and from school, medical appointments and extra-curricular activities.
  • Promoted language development skills through reading and storytelling.
  • Developed games and activities using arts and crafts to support learning and verbal skills.
  • Transported children to and from activities using personal or family vehicle.
  • Organized activities that enhanced children's physical, emotional and social well-being.
  • Encouraged children to be understanding and patient with others.
  • Worked with parents to develop and implement discipline programs to promote positive behavior.
  • Provided developmentally appropriate activities for children.
  • Helped children complete homework assignments and school projects.
  • Supervised children engaged in physical activity, learning and social skills with peers.
  • Coordinated playdates and outings to meet children's physical and social needs.
  • Supervised children on playground to help develop physical and social skills.
  • Identified warning signs of emotional and developmental problems in children.
  • Stayed current on toy and child-related recalls and safety warnings.

Education

Associates - BioChemistry

Northern Virginia Community College
Manassas, VA
06.2016

Bachelor of Science - Cellular Development and Gene Editing

Northern Virginia Community College
Annandale, VA
08.2022

CRC Risk Adjustment Coding Certification - Risk Adjustment Coding And Hedis Gaps

AAPC
Online
01.2024

Skills

  • Performance Improvement
  • Effective Customer Communication
  • Operational Efficiency
  • Program Leadership
  • Program Support
  • Performance Metric
  • Constructive Feedback
  • Training Team Members
  • Training Initiatives
  • Commuinication
  • Project Management
  • Customer Interaction
  • Quality Control
  • Customer Acquisition
  • Team Goals
  • Conflict Resolution Tactics
  • Implementation Strategies
  • Status Updates
  • Standard Operating Procedure
  • Customer Loyalty
  • Customer Needs Assessments
  • Regulatory Compliance
  • Operational Planning
  • Business Growth
  • Excel
  • Data Entry
  • Implementation
  • Supervisory Skills
  • Team Leading
  • Interpersonal Communication
  • Presentations
  • Expenses
  • Risk Adjustment
  • Program Management
  • Computer Literacy
  • Program Development
  • Organized
  • Detail Oriented
  • Improvement Plans
  • Process Improvement Initiatives

Accomplishments

  • Supervised team of 30 staff members.
  • Used Microsoft Excel to develop goal tracking spreadsheets and data reports.
  • Documented data deep dives for market growth and development.
  • The training of my team members in the Southeast Region with Agilon.
  • Work closely with leadership and clinical leadership to drive goals and implantation.
  • Documented and resolved low assessment rate which led to 92% resulting in meeting the mid year goal.
  • Contributed to the standardization of reporting.
  • Created reporting reflecting new changes with V24 vs V28 ICD-10 Coding for provider, coder, and market education.
  • Created team huddles to actively stay connected with my team and their needs as well as give any company updates increasing communication and support.
  • Achieved a reduction to 2 weeks from for by introducing Monday.com for PMRR New Reviewer on boarding tasks.
  • Obtained my Belonging Certification with Agilon for fostering an inclusive and diverse culture. Our diverse background, thought, and experience among employees, our physician partners, and our senior patients serve as a source of our strength. We seek and listen to varied perspectives and experiences to support our growth as professionals and individuals.
  • I am apart of the mentorship program with Agilon to help anyone who is interested in growth in any capacity whether that be career or personal goals achieve them.
  • Deck preparation and setting agenda items for all meetings deck.
  • Computer skills: Ability to create and maintain documents using excel, microsoft word, powerpoint, and outlook.
  • Ability to apply principals of logical or scientifically thinking to a wide range of intellectual and practical problems.
  • Ability to work on mathematical concepts and apply them to practical situations.
  • Work closely with markets to meet data needs and work flows.


Timeline

Regional Program Manager

Agilon Health
04.2022 - Current

Claims Specialist

Guardian Life
06.2021 - 03.2022

Reception Coordinator

Carolina Oral and Maxillofacial Surgery Center
12.2020 - 06.2021

Shift Supervisor/ Manager

Starbucks
01.2019 - 02.2020

Receptionist

Elite Shooting Sports
10.2018 - 06.2019

Apparel Coordinator / Cashier

Dicks Sporting Goods
04.2012 - 03.2014

Apparel Lead

Sports Authority
10.2011 - 04.2012

Nanny

Don and Beth Salvaggio
01.2011 - 11.2011

Associates - BioChemistry

Northern Virginia Community College

Bachelor of Science - Cellular Development and Gene Editing

Northern Virginia Community College

CRC Risk Adjustment Coding Certification - Risk Adjustment Coding And Hedis Gaps

AAPC

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Lindsay R. Barnes