Cappi Phillips
Amarillo,Texas
Summary
Accomplished healthcare management professional with extensive experience in various capacities of Health IT. Reporting for multiple third parties, including governmental reimbursement programs for provider incentives. Extensive analysis of both professional and technical data. Oversee departmental and institutional expenses, revenue and operations. Manage a team of nurses and healthcare business analysts for patient care and provider analysis, as well as system maintenance and operations.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Director
Texas Tech University Health Sciences Center
07.2012 - Current
- Manage three departments: Clinical Transformation and Healthcare Quality, Electronic Medical Records and Medical Records
- Serve as a resource and expert in health care reform and lead projects pertaining to various governmental programs and initiatives for state and federal reporting (including but not limited to Meaningful Use, PQRS, MIPS, MACRA, DSRIP and TIPPS)
- Advanced functional knowledge of electronic medical records and medical record requirements and legalities
- Work directly with healthcare providers to facilitate workflow redesign efforts for efficiency and compliance, as well as reform implications
- Extensive analysis of systems and procedures in healthcare practices in order to effectively recommend improvements
- Budget creation and analysis for multiple accounts
- Serve as a liaison with providers and vendors on contracts and implementations
- Work directly with contacts at Medicaid, CMS and HHSC for issue resolution
- Aid in developing marketing material and knowledge sharing information, as well as trainings for providers and staff
- ICD-10 subject matter expert creating an ICD-10 Assessment Tool, as well as teaching classes on the subject
- Interact with clients for billing and coding efficiency, as well as documentation maintenance for all states
- All aspects needed for telemedicine services, including implementation, billing, coding and medical records
- Creation of a telemedicine training program for billing and coding published through TTUHSC
- Grant application and writing assistance, including program research
Business Analyst/Operations Supervisor
StrataCare/CS Stars/Corporate Systems
07.2002 - 07.2012
- All aspects of medical bill audit, research, analysis and management of the audit team, especially with regards to compliance for all states
- Hiring for audit positions, as well as terminations
- Development of an audit team from ground level
- Worked directly with clients to maintain their expectations and client relationships, as well as audit goals
- Assisted in maintaining a budget, both revenue and goals, as well as expenses
- Training of customers, both internal and external, on product knowledge
- All aspects of Workers’ Compensation medical bill processing for Texas and California claims
- Development of product enhancement and software customizations, as well as QA
- Contacted third parties on behalf of the client for issue resolution, as well as monitoring of third party feeds
Senior Medical Adjuster/Auditor
Texas Mutual Insurance
01.1998 - 06.2002
- All aspects of medical bill audit, tracking and documentation under Texas state guidelines
- Responsible for hospital, pharmacy, dental and provider billing
- Daily interaction with healthcare providers regarding reimbursement issues and disputes
- Work closely with Workers’ Compensation Specialists, Case Managers and all aspects of pre-authorization
- Process and determine payment for all charges submitted on all bill types
- Documentation review
- Process all appeals
- Fraudulent claims research and document gathering
- Research accuracy of ICD-9/CPT coding
- Ongoing training as required for license maintenance
Office Manager
Dr. John Streit
06.1996 - 01.1998
- All aspects of medical office management, as well as patient file management
- Hiring and terminations
- Purchasing and selling of merchandise
- Accounts payable, receivable and payroll
- All provider scheduling
- Billing and collections
- Assist physician when requested
- ICD-9/CPT coding accuracy, as well as electronic billing
- Responsible for maintaining a budget at all times
- All correspondence to other physicians/organizations on behalf of physician
Education
Associate of Science Degree - Nursing
South Plains College
Levelland, TexasMBA - Applied Science in Health Services Management
Midland College
Midland, Texas05.2020
Health IT Liaison Certification - undefined
Bachelor of Applied Services - Health Services Management, Clinical Informatics
Skills
- Clinical Data Analytics
- Healthcare Quality Metrics
- Government Reporting
- Medical Bill Audit
- Quality Assurance and Legalities
- Revenue Cycle Audit and Management
- Software Analysis and Support
- Microsoft Office Tools (Project, Excel, Word)
- SharePoint
- SalesForce
- Various EMR Programs with emphasis on Allscripts
Accomplishments
- Founder of the West Texas Chapter of HIMSS
- Collaborative writing and creation of the Frontiers in Telemedicine Billing and Coding Workbook and Training Program
- Speaker during the 2014 Texas Regional Extension Centers Conference
Certification
Licensed Workers' Compensation Adjuster for the State of Texas
Timeline
Director
Texas Tech University Health Sciences Center
07.2012 - Current
Business Analyst/Operations Supervisor
StrataCare/CS Stars/Corporate Systems
07.2002 - 07.2012
Senior Medical Adjuster/Auditor
Texas Mutual Insurance
01.1998 - 06.2002
Office Manager
Dr. John Streit
06.1996 - 01.1998
Associate of Science Degree - Nursing
South Plains College
MBA - Applied Science in Health Services Management
Midland College
Health IT Liaison Certification - undefined
Bachelor of Applied Services - Health Services Management, Clinical Informatics
Similar Profiles
Crystal GonzalezCrystal Gonzalez
CASHIER SUPERVISOR at TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTERCASHIER SUPERVISOR at TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Teresa NunezTeresa Nunez
Director of Operations at Texas Tech University Health Sciences CenterDirector of Operations at Texas Tech University Health Sciences Center
Shreyas SridharanShreyas Sridharan
Grant Analyst at Texas Tech University Health Sciences Center (TTUHSC)Grant Analyst at Texas Tech University Health Sciences Center (TTUHSC)
Jocelyn AdamsJocelyn Adams
Family Nurse Practitioner – Burn/Wound at Texas Tech University Health Sciences CenterFamily Nurse Practitioner – Burn/Wound at Texas Tech University Health Sciences Center
CHRISTINA DAWSONCHRISTINA DAWSON
Teacher's Assistant at Amarillo ISDTeacher's Assistant at Amarillo ISD