HAROLD BARNES
Mansfield,MA
Summary
Experienced professional with a proven track record of optimizing processes and leading high-performing teams. Known for sharp analytical abilities and dedicated to delivering results. Valued for promoting teamwork and adapting to changing demands. Proficient in Pharmacy Receivables, skilled in team management and improving operations through strategic enhancements that increase productivity and efficiency. Recognized for strong problem-solving skills and sound decision-making abilities.
Overview
41
41
years of professional experience
Work History
Manager, Revenue Cycle Management
Shields Health Solutions
11.2016 - 07.2025
- Oversee Revenue Cycle Management Department that currently supports 34 individual pharmacies with 23 Hospital systems in 14 states with over 150 million in monthly receivables.
- Fully manage pharmacy reimbursement and reconciliation, continually work to improve optimization, and support specialized needs, such as: Patient AR, HCFA 1500 manual billings, Pharmacy Part B billing, cash reconciliation, etc. In 2019 launched a Medical Billing Team to support billing for Hemophilia and LDD related specialty medications. Provide monthly reports to include payer adjustments, audits, payer initiated take backs (DIR, Payer fees, etc.) and actively keep current with trends that may impact a pharmacies bottom line.
- Utilize multiple reconciliation platforms (InMar, TPMS, Provider Pay and McKesson Concierge), as well as working knowledge with multiple dispensing systems (QS1, RX30, EPIC, etc.) and multiple POS systems (EMPOROS, RMS, etc. )
- Act as department representative for all new pharmacy implementations from start to go-live, as well as, collaborate with multiple stakeholders such as pharmacy management teams, implementation teams, contracting, hospital finance and treasury departments.
Manager, 3rd Party Audit, Claims Reconciliation and Unapplied Cash
PharMerica
09.2007 - 11.2016
- 3rd Party Audit: Manage all inbound 3rd Party Insurance Pharmacy Audit communications (Single Claim, Desk or On-Site Audits) and distribute to pharmacies nationwide, as well as, ensure compliance, deadline adherence, appeal support, enlist internal resources when needed and develop strong relationships with auditors and payers. Provide detailed analysis of claims in audit during the initial, appeal and final stages of an audit. Report monthly on all audit activity and identify at risk revenue related to audits to senior management. In two years reduced audit claims discrepancy rate from 5.8% to 2.76% and implemented help sheets and standardized processes that resulted in improved audit outcomes.
- Claims Reconciliation: Manage all company 3rd Party Insurance accounts receivables focusing on pharmacy claims older than 90 days. Successfully reduced 120 days + aged claims from over $6.3 million to less than $400,000 in 5 years. Manage a staff of 24 associates and streamlined associate monthly work queue, developed department P&P’s, productivity performance tracking and quality assurance programs. Provide senior management and accounting departments with Account Receivable balances, at risk revenue, cash to revenue, payer trends & performance and variance/write off revenue adjustments.
- Unapplied Cash: Oversee the reconciliation of funds not be applied to the claim at time of payment. Identify revenue from reversed or credited claims not recouped by payers and execute refunds. Provide monthly Unapplied Cash balances and refund activity. Established strong communications with 3rd Party payers and developed process for identifying and resolving cash posting and reconciliation issues. Oversee and perform quarterly SOX testing of compliance protocols, as well as, collaborate with internal and external auditing agencies.
- Exceeded individual and department performance goals - as well as – exceeded Short Team Incentive goals for the past 4 years.
Trainer
APM Trainer - Corporate Pharmacy Operations
05.2010 - 09.2011
- Trained Order Entry and pharmacy staff on pharmacy claim denial resolution at over 43 pharmacy locations throughout the US. Authored and developed a 194-page Pharmacy POS Denial Resolution Training Manual and created help sheets for post-training use by Pharmacy staff - which was used as a model for companywide use. Provided on-going support and training to all company pharmacy locations on a daily basis.
RBO Trainer, NE Region
07.2009 - 04.2010
- Supported the NE Regional Billing Office (RBO) located in Brockton, MA for all new hire and existing staff training needs in the Adjudication, Admissions, Census and Collection departments. Developed new hire training manual, help sheets, shadow-training and performed quality assessment audits for all new and existing staff.
Claims Adjudication Supervisor
09.2007 - 07.2009
- Supervised 2nd shift staff in denied resolution of adjudicated prescription claims with 3rd Party Insurance payers - such as Medicare Part D, Medicaid, Hospice and private insurance plans. Active in hiring and training, randomly audited associate work to ensure accuracy and compliance. Responsible for compliance with daily SOX requirements, staff scheduling, goal setting, approving all revenue adjustments and managing projects as assigned.
Business Administrator
Village Pediatrics, LLC
01.2003 - 01.2007
Region Director of Finance and Administration - Billerica, MA
International Churches of Christ (ICOC)
01.1999 - 01.2002
Assistant Administrator - Billerica, MA
International Churches of Christ (ICOC)
01.1997 - 01.1999
Retail Store Operations - Sportline America (TradeCorp, Inc.)
Business Consultant - Self Employed
05.1997 - 09.1997
Outlet Store Apparel Buyer and Mobile Retail Manager
Reebok International
10.1995 - 01.1997
Director of Buying, Mexico and Canada Divisions
Footlocker International
01.1992 - 01.1995
Manager, NFL and NBA Special Events
Footlocker USA - Corp. Headquarters
01.1992 - 01.1994
International Merchandise Coordinator, Buyer, Mexico Divisions
Footlocker USA - Corp. Headquarters
01.1990 - 01.1992
Merchandise Manager, Multiple Categories
Footlocker USA - Corp. Headquarters
01.1988 - 01.1990
Associate Merchandise Manager
Footlocker USA - Corporate Headquarters
01.1987 - 01.1988
Store Manager
Footlocker USA - Rapid City, SD
01.1987 - 01.1987
Assistant Store Manager
Footlocker USA - Bismarck, North Dakota; Minneapolis, MN
01.1985 - 01.1986
Education
Master in Business Administration - Healthcare Administration
University of Mary
Bismarck, ND01.2008
Bachelor of Arts in Business Administration - Management, minor Theology
University of Mary
Bismarck, ND01.2006
Skills
- Client support
- Collaborative team management
- Prioritization and scheduling
- Strategic decision-making
Awards
Professional Recognition, Executive Leadership Award (for general management and measurable profit contribution), Footlocker International - New York, NY, 1993, Human Relations Award- Awarded and voted by the class membership, Dale Carnegie - Missoula, MT, 1982
Timeline
Manager, Revenue Cycle Management
Shields Health Solutions
11.2016 - 07.2025
Trainer
APM Trainer - Corporate Pharmacy Operations
05.2010 - 09.2011
RBO Trainer, NE Region
07.2009 - 04.2010
Manager, 3rd Party Audit, Claims Reconciliation and Unapplied Cash
PharMerica
09.2007 - 11.2016
Claims Adjudication Supervisor
09.2007 - 07.2009
Business Administrator
Village Pediatrics, LLC
01.2003 - 01.2007
Region Director of Finance and Administration - Billerica, MA
International Churches of Christ (ICOC)
01.1999 - 01.2002
Retail Store Operations - Sportline America (TradeCorp, Inc.)
Business Consultant - Self Employed
05.1997 - 09.1997
Assistant Administrator - Billerica, MA
International Churches of Christ (ICOC)
01.1997 - 01.1999
Outlet Store Apparel Buyer and Mobile Retail Manager
Reebok International
10.1995 - 01.1997
Director of Buying, Mexico and Canada Divisions
Footlocker International
01.1992 - 01.1995
Manager, NFL and NBA Special Events
Footlocker USA - Corp. Headquarters
01.1992 - 01.1994
International Merchandise Coordinator, Buyer, Mexico Divisions
Footlocker USA - Corp. Headquarters
01.1990 - 01.1992
Merchandise Manager, Multiple Categories
Footlocker USA - Corp. Headquarters
01.1988 - 01.1990
Associate Merchandise Manager
Footlocker USA - Corporate Headquarters
01.1987 - 01.1988
Store Manager
Footlocker USA - Rapid City, SD
01.1987 - 01.1987
Assistant Store Manager
Footlocker USA - Bismarck, North Dakota; Minneapolis, MN
01.1985 - 01.1986
Bachelor of Arts in Business Administration - Management, minor Theology
University of Mary
Master in Business Administration - Healthcare Administration
University of Mary
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