Brian Wesley Barnes has over 18 years of experience in managed healthcare, with a focus on credentialing, claims examining, and medical billing. He has held various roles at HealthPartners, including Credentialing Tech II, Claims Customer Service Examiner, Patient Accounting Representative, and Senior Claims Examiner. Barnes is well organized, detail oriented, and able to manage multiple projects to meet deadlines. He maintains a full profile on LinkedIn at https://www.linkedin.com/pub/wesley-barnes/b5/934/99.

1. Brian Wesley Barnes "Wes Barnes"
400 ForestPark Road, #B2-9, Madison,TN 37115 404.966.7473 bwbofatlanta@yahoo.com
Medical Billing Credentialing /ProviderEnrollmenent Claims Examiner
PROFESSIONAL PROFILE
Innovative and resourceful expert with over 18 years of experience in managed healthcare. Credentialing,
claims examining, medical billing professional, with strong communication and interpersonal skills. Well
organized, very detail oriented, with exceptional ability to manage multiple projects meeting tight
deadlines. I am a motivated professional, with the combined experience necessary to contribute to
advance initiatives of the team, department, and corporation. Full profile available at LinkedIn-
https://www.linkedin.com/pub/wesley-barnes/b5/934/99.
Experience
HealthPartners
Promoted to various roles
April, 2002-November 2014
ClaimsCustomer Service Examiner
April, 2012-November, 2014
While continually awarded incentives for exceeding both service and productivity requirements.
Primary responsibilities: Ensured Provider education regarding medical policies, claims processing,
coordinating appeals, initiating adjustments, and credentialing requirements.
Key Contributions:
• Successfulcontinued training in claims examining, Education liaison for providers.
• Initiating review of Cigna pricing verifications.
• Mentoring of new employees.
• Achieved further Medical Terminology training via https://www.universalclass.com/.
• (Previous completed JEPS (Job Effectiveness Prediction System) testing.
CredentialingTechII
December, 2010-April, 2012
Successfulpreparation of provider credentials for board review and contract enrollment approval from
CAHQ applications was the most interesting role ever held at HealthPartners.

2. Primary responsibilities: Verification of all provider education, licenses, any license actions, work history,
facility affiliations, communication to obtain corrected information on attestation questions.
Key Contributions:
• Initiating and creating provider profiles in the CACTUS system.
• Expertly Reviewing CAHQ,and state universal credentialing applications for Minnesota, Wisconsin,
Iowa, South and North Dakota.
• Communication Development with providers.
• Provider education and customer service regarding credentialing requirements.
• Preparing records for board review of license actions & malpractice claims.
• Clarifying further information as needed from the provider per board request.
Patient Accounting Representative.
July, 2006-December, 2010
Promoted to dedicated service and billing representative for Company Clients; such as the MN
department of Transportation, Regions Hospital, and HealthPartners,utilizing all available resources for
payment collection.
Team contributor for successfulreimbursement for government (Medicare, Medicaid, Tricare) accounts.
Primary responsibilities: Dedicated/ only service representative for company clients, initiating coding
review, customer service to patients for billing, collection arrangements, successfulappeals resulting in
payment from government programs, successfully obtaining retroactive authorizations for government
corrected payments.
Key Contributions:
• Achieved continued training in EPIC Software for billing and medical records
• Established new Client Relations and collections.
• Designated reallocation of misapplied client funds of $60,000 from earlier in 2006, contributing 75%
towards meeting end of year fiscal goals.
• Collaborated and drafted previous nonexistent policies for company clients.
• Coordinated patient release of information forms for government billing.
• Initiated Cross training of patient accounting representatives for government release of information
forms.
SeniorClaims Examiner

3. July, 2005- July, 2006
Achieving consistent claims adjudication for dedicated and multiple groups provided greater
understanding to the HealthPartners managed care insurance division.
Key Contributions:
• Successfully completed JEPS (Job Effectiveness Prediction System) testing.
• Certified claims examiner training for HealthPartners.
• Consistently exceeded requirements in both productivity and quality for claims adjudication.
• Coordinated contractual discounts.
PatientAccounting Representative
April, 2002-July, 2005
Originally joining a dedicated team for billing to HealthPartners insurance, I was able to move to a more
expanded contracted team with increased responsibility and insurers. Primary responsibilities: Successful
claims submission, insurance follow-up BCBS timely payments, initiating coding review, drafting of
appeals increasing revenue,patient collections, and customer service.
Key Contributions: .
• Mastered clinical medical terminology testing (later simplified for department guidelines).
• Increased payments from Blue Cross Blue Shield with encouraged enhancement of contracted clinics for
all levels of care.
• Increased response and payment turnaround from contracted insurance plans, such as Blue Cross and
Blue Shield, Preferred One,and Medica.
• Successfulcompletion of Resolute, and later enhanced Epic Training
WesBarnes
400 ForestPark Road, #B2-9, Madison,TN 37115 404.966.7473 bwbofatlanta@yahoo.com