CHRISTINE BURK
RN
Monroe,NC
Summary
25+ years nursing experience in a variety of clinical settings, including Medical review and Case Management.
Overview
28
28
years of professional experience
Work History
Medical Reviewer II
Palmetto GBA
8 2022 - Current
- Pre-claim review of Home Health claims for the RCD contract following CMS guidelines in a home office setting
- Preceptor for new reviewers.
Supplemental Medical Review Contractor
Integrity M/ Noridian
10.2021 - 08.2022
- Performs post-pay review on Part B and B of A projects as assigned by Medicare
- Conducts additional research to identify potential fraud and abuse
- Maintains 98-100% QA scores consistently.
Medical Reviewer II
Palmetto GBA RCD
07.2018 - 09.2021
- Medical review of Medicare Part A Home Health claims following CMS guidelines from a home office setting
- Preceptor for new reviewers
- Joined the QA team in 3/2021.
Lead Claims Review Analyst
NCI Inc/AdvanceMed
09.2015 - 06.2018
- Review of pre and post pay Part B Medicare claims following CMS guidelines
- Self-motivated and able to work independently from a home office setting.
Medical Reviewer III
Palmetto, Railroad Retirement Board
07.2008 - 06.2015
- Medical review of Medicare and Railroad Retirement Board claims, including pre and post pay
- Trained in all areas of Part B.
Case Manager
Hospice, Helping Hands Hospice
02.2006 - 06.2008
- Provided information to families of prospective Hospice patients
- Admitted new clients for Hospice services in Darlington and surrounding counties
- Provided palliative care to clients, and emotional support to family members.
Staff/charge nurse
Carolina Pines Regional Medical Center
01.1996 - 09.2007
- Provided direct care to post parum, OB/GYN surgery and antepartum patients
- Cross-trained to newborn nursery and pediatrics, as well as medical and surgical units
- Mentor for new staff members.
Case Manager
Chesterfield Co Board of Disabilities and Special Needs
04.2005 - 02.2006
- Provided assessment and medical intervention to clients during clinic hours
- Managed and maintained medications in client's homes
- Scheduled appointments for any medical needs and arranged transportation.
Education
Associate Degree in Nursing Nursing -
Florence Darlington Technical College
01.1993 - 12 1995
Skills
- CMS medical reviewer with 16 years of experience in Part B, B of A, and Home Health
- Case manager responsible for the health management of mentally and physically disabled clients
- Hospice Case Manager
- OB, newborn nursery, pediatrics, med/surg nursing in hospital setting
Additional Information - Licenses
Registered Nurse in the State of NC, License number 252306
Timeline
Supplemental Medical Review Contractor
Integrity M/ Noridian
10.2021 - 08.2022
Medical Reviewer II
Palmetto GBA RCD
07.2018 - 09.2021
Lead Claims Review Analyst
NCI Inc/AdvanceMed
09.2015 - 06.2018
Medical Reviewer III
Palmetto, Railroad Retirement Board
07.2008 - 06.2015
Case Manager
Hospice, Helping Hands Hospice
02.2006 - 06.2008
Case Manager
Chesterfield Co Board of Disabilities and Special Needs
04.2005 - 02.2006
Staff/charge nurse
Carolina Pines Regional Medical Center
01.1996 - 09.2007
Associate Degree in Nursing Nursing -
Florence Darlington Technical College
01.1993 - 12 1995
Medical Reviewer II
Palmetto GBA
8 2022 - Current