Kerri Capello
Baton Rouge,Louisiana
Summary
Dynamic professional with extensive experience at the Louisiana Department of Health, excelling in claims management and policy development. Proven ability to analyze complex data sets and foster collaboration among stakeholders. Proficient in Microsoft applications and basic SQL coding, with strong leadership skills that drive team performance and continuous improvement.
Overview
35
35
years of professional experience
Work History
Program Monitor (part-time)
Louisiana Department of Health
08.2018 - 08.2025
- Develop, test and verify business rules for processing and encounters, i.e in-lieu-of, value add, non-emergency ambulance, emergency ambulance and non-emergency, non-ambulance encounter editing.
- Develop, test and verify provider registry business rules for care at home, doula, outpatient lactation consultant and non-emergency, non-ambulance provider registry records.
- Analyze large data sets to verify fee-for-service claim, encounter and provider registry system requirements are met.
- Document and share business requirements and expected impact with end users (providers and external contractors, i.e. fiscal intermediary and MCOs).
- Provide language for MCO System Companion Guide updates for in-lieu-of and transportation mileage encounter reporting.
- Provide language for MCO Policy Manual on Third Party Liability.
- Serve as a bridge between Medical providers, Medicaid enrollees, fiscal intermediary and MCOs to resolve claims and provider registry issues.
- Provide language for MCO System Companion Guide and MCO Policy Manual.
- Develop modernized fee schedules and legends.
- Developed, tested and implemented ambulance treatment-in-place encounter and fee-for-service claims processing.
MMIS Section Chief
Louisiana Department of Health
01.2016 - 04.2018
- Administered Fiscal Intermediary and Third Party Liability contracts.
- Oversight of 2015 Managed Care Organization onboarding for electronic file exchanges to and from fiscal intermediary, i.e. encounter, provider registry and non-EDI file transfers.
- Worked with LDH policy and fiscal staff to reinstate Louisiana Health Insurance Premium Payment Program (LaHIPP).
- Direct Supervision of 4 Unit Managers.
- Indirect Supervision of 36 Program Managers.
- Manage four (4) Units- Recovery & Premium Assistance (RPA), Claim & Encounter & Recipient Reimbursement, MMIS Operations and Third-Party Liability (TPL).
- Evaluated employee performance providing constructive feedback for continuous improvement efforts.
- Updated MCO System Companion Guide, MCO Policy Manual, and Fee-for-Service Policy Manuals.
- Developed strong relationships with external partners (MCO, fiscal intermediary and TPL vendor) to ensure timely collaboration on projects.
- Work with internal and external partners to develop and manage corrective action plans.
MMIS Program Unit Manager
Louisiana Department of Health
01.2015 - 01.2016
- Develop and administer claims, encounters and third-party liability policies and procedures ensuring compliance with State and Federal laws.
- Research and resolve fee-for-service claim, encounter and MCO file transfer denials and rejections.
- Develop, test and implement file exchange transfers between external partners (fiscal intermediary, TPL vendor and MCOs).
- Audit claims, encounters and provider registry records.
- Onboard 5 MCOs and Dental Plan Manager.
- Evaluated employee performance regularly for professional growth opportunities, accountability measures, and feedback-driven improvement strategies.
- Ensured encounter compliance through regular audits,
- Resolved conflicts among team members to maintain a positive working environment.
- Provide responses to Louisiana Legislative Auditor questions around claims and encounters.
- Resolve CMS payment error rate (PERM) findings and respond with corrective actions.
- Update MCO System Companion Guide.
Program Manager
Louisiana Department of Health
03.2013 - 01.2015
- Served as MMIS liaison between Fiscal Intermediary and Louisiana Behavioral Health vendor.
- Analyze and resolve weekly fee-for-service claim error reports and CMS MSIS error reports.
- Update Louisiana Behavioral Health System Companion Guide.
- Worked with policy staff to develop new provider types and types of services for new Medicaid programs.
Registered Respiratory Therapist-Asthma Educator
Earl K. Long Medical Center
07.1990 - 03.2013
- Managed an Asthma Disease Management Program .
- Managed Outpatient Pulmonary Function Lab.
- Managed and operated mechanical ventilators to deliver airway management.
- Mentored new employees, providing guidance on best practices in respiratory therapy treatments and techniques.
- Provided emergency response during cardiac arrests or other life-threatening situations utilizing advanced life support measures when required.
Education
Associate of Science - Respiratory Therapy
Nicholls State University
Thibodaux, LA07-1990
Skills
- Knowledge of Microsoft applications, word, excel, powerpoint, outlook and excel
- Basic SQL coding
- Zoom
- Documentation skills
Timeline
Program Monitor (part-time)
Louisiana Department of Health
08.2018 - 08.2025
MMIS Section Chief
Louisiana Department of Health
01.2016 - 04.2018
MMIS Program Unit Manager
Louisiana Department of Health
01.2015 - 01.2016
Program Manager
Louisiana Department of Health
03.2013 - 01.2015
Registered Respiratory Therapist-Asthma Educator
Earl K. Long Medical Center
07.1990 - 03.2013
Associate of Science - Respiratory Therapy
Nicholls State University
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