Christina Barnes
Raleigh
Summary
Dynamic Reimbursement Manager with proven expertise at Caremetx Inc in revenue cycle management and denial management. Adept at analyzing complex data to identify reimbursement opportunities, enhancing financial reporting accuracy. Recognized for exceptional leadership and communication skills, driving process improvements that resulted in timely revenue resolution and optimized claims processing.
Overview
20
20
years of professional experience
Work History
Reimbursement Manager / Clinical Researcher
Caremetx Inc
Bethesda
10.2018 - 05.2025
- Company Overview: Pharmaceutical (Headquarters)
- Participate in internal system wide revenue cycle meetings designed to improve revenue cycle process
- Analyze and make recommendations to all revenue cycle in regards to Federal Health Services
- Lead project initiatives to implement new processes or modifications to existing processes that result in timely revenue resolution
- Collect, aggregate and analyze data from multiple sources to facilitate identification of trends, interdependencies and root causes
- Design and deOrient new Reimbursement Specialists to the workflow of the department and act as a mentor to ensure their professional growth develop dashboards and reporting that deliver meaningful and accurate conclusions from the monitoring efforts
- Prepared and analyze Medicaid/Medicare cost reports and identified reimbursement opportunities
- Researched all major plans for reimbursement opportunities
- Investigate denial trends and initiate communication with root cause owners and action owners to prevent future claim edits, denials, and report these issues in timely manner to leadership
- Oversee the preparation of appeals and re-openings of cost reports and supporting analyses for assigned facilities; help ensure the accurate and timely settlement of all issues.
- Support the Reimbursement Specialist(s) (if any) in their efforts with researching and writing appeals
- Prepare and support the calculation of revenue deductions, contractual allowances and other reserves and settlement accounts for assigned facilities; help ensure the accuracy of monthly and annual financial reporting
- Pharmaceutical (Headquarters)
Reimbursement Case Manager
Smith and Nephew
Columbia
08.2014 - 10.2018
- Company Overview: IT Pharmaceutical (Headquarters)
- Researched and Analyzed Medicare/Medicaid and all major plans cost reports for reimbursement opportunities
- Coordinates with inter-departmental associates as necessary.
- Communicates effectively with payors/plans to ensure accurate and timely benefit investigations/SOB.
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors.
- IT Pharmaceutical (Headquarters)
Reimbursement Case Management
Trialcard, Inc.
Raleigh
09.2009 - 08.2014
- Company Overview: Medical Firm (Headquarters)
- Managing the financial activities of patient payers from the time products or services are dispensed until the payment cycle ends.
- Acting as a liaison between billing departments and health clinicians, reimbursement specialists manage all functions regarding claims processing, such as overseeing disputed, delayed or rejected claim.
- Communicative, the need to be independent, decisive and interpersonal as they interact with patients; state, federal and private representatives, fiscal intermediaries; pharmacy partners and managed care case managers.
- Knowledgeable about federal, state and third-party claims processing.
- Analyze and Prepared Medicare/Medicaid and all major plans cost reports for reimbursement opportunities.
- Customer service and basic computer skills, including database monitoring and word processing.
- Medical Firm (Headquarters)
Branch Director
Has hem Healthcare Services
Durham
01.2005 - 08.2009
- Company Overview: Home health agency
- Serving as a Branch Director of a Home health agency, supervises the field and office staff.
- Assist the Chief Clinical Officer in meeting and exceeding standards for conditions of participation, minimum standards and Agency policy and procedures.
- Coordinate patient services appropriate to the age of the patients serviced within the Agency and the community.
- Knowledge of Medicare/Medicaid regulations cost reports and Sembra Care and JCAHO Home Care Standards; excel in clinical skills and analytical capabilities, outstanding oral and written communication skills to engage with staff/physicians and patients, excellent organizational skills, ability to lead and develop all staff members, and perform under stress and exercise self-control.
- Evidence of the practice of a high level of confidentiality, exercise sound and professional judgment at all times.
- Home health agency
Education
Associate of Arts - MA/MO
Medical Arts School
Raleigh, NC07.2009
Skills
- Claims processing
- Revenue cycle management
- Data analysis
- Financial reporting
- Cost report preparation
- Regulatory compliance
- Process improvement
- Denial management
- Customer service
- Team leadership
- Healthcare industry
- Microsoft office
- Appeals handling
- Commercial insurance
- Data recording
- Eligibility verification
- Bookkeeping
- Insurance verification
- ICD 9 coding
- Financial accounting
- HIPAA compliance
- Managed care
- Policy analysis
- HCPCS coding
- Client service
- ICD-10 coding
- Medical billing
- Copay collection
- Policy evaluation
- Medicare
- Medicaid
- Payment posting
- Account updating
- Expense tracking
- Organizational skills
- Microsoft Office Suite
- Written communication
- Adaptability and flexibility
- Billing statement review
- Customer account management
- Team collaboration
- Year-end reporting
- Deadline adherence
- Account reconciliation
- Financial statement analysis
- Vendor invoice processing
- CRM software
- Financial report creation
- Verbal and written communication
- Itemized statement preparation
- Excellent communication
- Office equipment operation
- Financial management
- Vendor account monitoring
- Work Planning and Prioritization
References
Available upon request.
Qualifications Summary
- Excellence in working in a fast pace environment, with the ability to perform in a multi task environment with emphasis on customers.
- Analyzed and prepared Medicare/Medicaid cost report and generated SOB to ensure accurate reimbursement and settlement estimates.
- Researched all major plans cost shares for reimbursement opportunities.
- Proficient with Microsoft Office Systems (including Microsoft Word, Microsoft Excel, Microsoft Powerpoint, Microsoft Access, Microsoft Outlook, Citrix, Gentiva, MEdiSOFT, and Misys, EMR). Quick path, Finesse, Fax maker, Fulfillment tool.
- Data entry, billing, payment, third party billing, insurance verifications, benefits, credentialing, payroll, management.
Timeline
Reimbursement Manager / Clinical Researcher
Caremetx Inc
10.2018 - 05.2025
Reimbursement Case Manager
Smith and Nephew
08.2014 - 10.2018
Reimbursement Case Management
Trialcard, Inc.
09.2009 - 08.2014
Branch Director
Has hem Healthcare Services
01.2005 - 08.2009
Associate of Arts - MA/MO
Medical Arts School
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