Kadiatou Barry-Sow

Prepared and participated in external audits such as CMS Data validation, MDV, and HSAG audits, as well as internal audits for the Compliance Team and G&A Leadership. Oversaw the daily monitoring of AOR and IRE/ALJ Compliance reports and validated daily timeliness metrics.

Led the review and resolution of complex appeals and grievances, ensuring compliance with CMS, Medicaid, and internal regulatory standards. Developed training materials and job aids for claim appeals and grievances, providing training to new A&G specialists.

Investigated claim appeals and grievances from members and providers by navigating multiple support systems to provide resolutions. Assisted in the development of training materials and Appeals and Grievance Templates to maximize overall department workflow and efficiency.

Supervised workflow and delegated tasks to staff to maximize production and meet performance goals. Managed store operations in the absence of the Store Manager, effectively communicating information to and from management.

Worked alongside the Nursing Home Administrator, gaining experience in budgeting, financial planning, and resource allocation. Rotated through various departments to understand resident needs and facility operations.

Completed a Bachelor of Arts in Healthcare Services Administration and Gerontology. The program provided a comprehensive understanding of healthcare management and the specific needs of the elderly population.