Keith Karsten is the Chief Operating Officer of Clinical Research Billing, Inc., an outsourced financial management firm supporting independent research sites and large SMOs nationwide. With more than 16 years of experience in clinical research finance, he brings end-to-end expertise across the full clinical trial financial lifecycle, including 12 years negotiating and developing clinical trial budgets and contracts and 10 years overseeing site Invoicing and payment operations. Having led finance departments for multiple SMOs, Keith has built high-performing teams and recovered millions in previously unbilled or unpaid revenue. He is recognized for improving financial efficiency, strengthening cash flow performance, and building scalable revenue infrastructures that help research organizations operate more sustainably in an increasingly complex clinical trial environment