NINFA CAPARROSO-KAM M.D., M.P.H.
Quezon City
Summary
Results-oriented achiever with a track record of consistently surpassing targets and driving success in fast-paced environments. Combining strategic thinking with hands-on experience, has a proven ability to deliver impactful solutions that enhance organizational performance. With a focus on driving results and a passion for excellence, dedicated to achieving success and making a significant impact in any role undertaken.
Overview
38
38
years of professional experience
1
1
Certification
Work History
Chief of Hospital II/Medical Center Chief in an acting capacity
Provincial Health Office
02.2021 - 01.2024
- Responsible for the overall management and administration of the hospital; formulation of policies, plans, programs and strategies to ensure implementation of health standards for the attainment of quality health care and high standards of clinical training for medical and allied medical personnel; and the day-to-day supervision and administration of the functional units
- Oversees the hospital compliance with DOH Licensing and PhilHealth Accreditation requirements
- Supervised claims submission to PhilHealth and monitors/evaluates return and denied claims
- Self-motivated, with a strong sense of personal responsibility.
- Skilled at working independently and collaboratively in a team environment.
- Passionate about learning and committed to continual improvement.
Provincial Health Officer II
Provincial Health Office
Northern Samar, Philippines
08.2020 - 01.2024
- Under the direction of the Provincial Health Board, is in-charge of the overall operations of the provincial hospital system in the province of Northern Samar and its compliance with licensing and PhilHealth requirements
- Serves as the Vice-Chairperson of the Provincial Health Board
- Together with the public health program managers, supervises the implementation of the different public of the Department of Health
- Serves as the Chairman of the Provincial Medical Scholarship Committee
- Serves as the Chairman of the Consignment Committee
- Together with the Provincial Health Board, leads the implementation Of Universal Health Care in the province of Northern Samar
- Played pivotal role liaising among diverse stakeholders including policymakers, donors and grassroots organizations working together toward shared goals pertaining improvement living conditions within communities served.
- Led multidisciplinary teams comprising nurses, doctors, pharmacists, nutritionists in providing holistic care tailored to individual needs.
- Collaborated with local government agencies to address social determinants of health, improving overall community wellbeing.
Administrator
Medi Link Health Services LLC
10.2019 - 07.2020
- Planning, directing and evaluating the operations of the agency to ensure provision of adequate and appropriate care and services
- Assures that all business conduct is above minimum standards required by law and the licensing and accreditation bodies
- Fiscal planning, budgeting and management of operations in accordance with fiscal parameters
- Implementing governing body directives and ensuring that appropriate service policies are developed and implemented
- Directing and monitoring organizational performance improvement activities
- Ensuring staff development including orientation, in-service education, continuing education, and evaluation of staff
- Coordinates with Medicare and Private Insurances regarding patient’s plans and benefits
- Reviews and approve contracts with Private Insurance Companies
- Ensuring the accuracy of public information materials and activities
- Informing the governing body and staff of current organizational, community, and industry trends
- Handled sensitive information discreetly, maintaining strict confidentiality at all times as required by company policy or legal regulations.
- Organized and executed quarterly staff training sessions, keeping team informed on latest administrative protocols and technology.
- Maintained personnel records and updated internal databases to support document management.
- Enhanced employee onboarding process, improving new hire satisfaction and reducing time to productivity.
Home Health Services Consultant
NK Healthy Concepts Corporation
10.2005 - 07.2020
- Provides assistance in survey preparation for existing Medicare certified Home Health Agencies (including conduct of annual agency evaluation, statistical report analysis and quarterly audit of clinical records)
- Formulates home health policies and procedures
- Provides training on home health medical coding, OASIS, clinical documentation, Outcome Based Quality Improvement (OBQI) Process, and home health Medicare Billing
- Mentored junior team members, sharing industry insights and best practices for improved performance.
- Conducted thorough needs assessments to accurately identify client requirements and develop appropriate solutions.
- Provided expert guidance on product offerings and services, enabling clients to make informed decisions based on their unique needs.
- Analyzed data trends to monitor performance metrics and inform future process improvements.
Centralized Medical Coding Specialist
Almost Family Hospital Partnership Division
09.2014 - 08.2019
- Reviews clinical documentation (hospital records, clinical assessments) to ensure appropriate diagnoses codes are assigned to the highest degree of specificity
- Reviews Patient’s Home Health Plan of Care to ensure that the skilled needs of every patient are met
- Identify areas for improvement among clinicians and agencies and makes recommendation as appropriate
- Evaluates assigned agencies in the following areas: comprehensive assessments using Medicare Outcomes Assessment and Information Set (OASIS), compliance with medical necessity per Medicare Benefit Policy Manual, and completeness and appropriateness of Plan of Care
- Collaborated with healthcare providers to clarify ambiguous or incomplete documentation, resulting in more precise medical codes.
- Reduced claim denials by consistently ensuring accurate and compliant coding practices in line with regulatory standards.
- Stayed current on industry trends and advancements through regular participation in professional development courses and seminars, enhancing overall job performance.
Assistant Administrator, Coder, Biller
Medi Link Health Services, LLC
02.2013 - 09.2014
- Assist the Administrator in the overall operation of the agency
- Assist the Administrator in meeting regulatory requirements
- Reviews clinical records to include hospital records and clinician assessment to assigned patients online and assign appropriate diagnosis codes in accordance with current CMS interpretive guidelines and based on current coding guidelines and conventions
- Prepares electronic and paper claims of home health patients and sends to corresponding payers
- Reviews and analyzes Casper Reports, Consumer Reports, Billing Reports and identifies problem areas for corrective action
- Reviews policies and procedures and recommends to the Board of Directors revisions as appropriate to stay in compliance with Federal and State laws and regulations
- Serves as the lead person in the Annual Program Evaluation of the agency
- Assisted with employee onboarding process, providing new hires with necessary resources for success in their roles.
- Assisted in the development and implementation of new policies and procedures, ensuring compliance with industry best practices and established regulatory standards.
- Prepared comprehensive reports on various aspects of the organization''s operations, informing strategic decision-making processes at the executive level.
- Proactively identified areas for improvement in administrative processes, proposing innovative solutions that streamlined operations without sacrificing quality.
Quality Assurance/Improvement Director, Coder and Biller
WeBridge Home Health Corporation
Linconwood, Illinois
01.2008 - 02.2013
- Company Overview: Linconwood, Illinois, U.S.A
- Chairs and coordinates internal quality assurance committee, participates in other facility committees which impact the Quality Assurance/Improvement Program and acts as liaison with other agencies and external reviewers associated with quality assurance/improvement
- Gathers and analyze data through audits, interviews and other activities in order to monitor the quality and appropriateness of services and function (e.g chart audits on aspects of care); writes narrative reports summarizing findings
- Designs tools, systems and methodologies for data collection and recommends actions
- Recommends new/revised operational or administrative policies/procedures to maintain quality care at the same time maintain cost effectiveness and cost efficiency in the utilization of services
- Develops and conduct educational & training programs for and provide technical assistance to facility staff in all aspects of quality assurance and seek to ensure that all relevant employees and management are knowledgeable of and comply with pertinent Federal State Laws
- In consultation with the patient’s physician and visiting nurse, assigns/reviews diagnoses codes of home health patients
- Coordinates with Medicare and Private Insurances regarding patient’s plans and benefits
- Submits request for anticipated payment (RAP) and final claims of home health patients and monitors payments from Medicare and Private Health Insurance payers
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
- Pioneered adoption of sustainable practices, leading to industry recognition and awards.
Coding Consultant
Fazzi and Associates
12.2011 - 07.2012
- Reviews clinical records to include hospital records and clinician assessment to assigned patients online and assign appropriate diagnosis codes in accordance with current CMS interpretive guidelines and based on current coding guidelines and conventions
- Enhanced coding accuracy by conducting thorough code reviews and providing detailed feedback to clients.
Quality Assurance/Improvement Director
Sure Care Home Health Corp
Glendale Heights, Illinois
12.2006 - 12.2007
- Company Overview: Glendale Heights, Illinois, USA
- Job Description same as above
- Glendale Heights, Illinois, USA
Quality Assurance/Improvement Director
Caring Professionals Home Care
Chicago, Illinois
03.2003 - 12.2006
- Company Overview: Chicago, Illinois, USA
- Job Description same as above
- Chicago, Illinois, USA
Provincial Health Officer I
Provincial Health Office
N. Samar, Philippines
01.2000 - 01.2001
- Company Overview: N
- Samar, Philippines
- Assists the Provincial Health Officer II in the overall achievement of the goals and objectives of the Provincial Health Office of N
- Samar, Philippines
- In the absence of the Provincial Health Officer II takes charge of the entire operation of the Provincial Health System of the Province of the N
- Samar
- Heads the Management Committee of the Provincial Health Office
- Heads the Quality Assurance Program Committee of the Provincial Hospital
- Liaise and forms networks with other government agencies, non-government organizations, and other health organizations, both local and international
- Led multidisciplinary teams comprising nurses, doctors, pharmacists, nutritionists in providing holistic care tailored to individual needs.
- Collaborated with local government agencies to address social determinants of health, improving overall community wellbeing.
- Fostered partnerships with non-governmental organizations to support the implementation of various public health programs.
- Assessed impact public health interventions leveraging robust monitoring and evaluation frameworks aiding decision-making related future programmatic priorities.
College Secretary
University of the Philippines
01.1998 - 01.2000
- Company Overview: College of Public Health
- In charge of student enrollment, dropping of subjects, transfers and other related activities
- Manages student data (including grades), academic and curricular information
- Schedules academic and curricular activities of the College
- Participates in curriculum planning and revisions
- Member of the executive committee of the College
- Assists the Dean and the different Department Chairpersons of the College in academic and curricular matters
- Promoted a positive image of the organization through clear communication both internally with colleagues and externally with clients.
Assistant Professor IV
University of the Philippines
01.1997 - 01.2000
- Company Overview: College of Public Health
- Teaches Principles, Concepts, and Practice in Health Service Administration, Primary Health Care, Health and Development, Maternal and Child Health, and Human Resource Management in Health Services Organization
- Conducts public health researches
- Provides extension services in the form of consultancy, or as resource speaker and/or trainer to the Philippine Department of Health, other government agencies and non-government agencies
- College of Public Health
Medical Specialist IV/Chief of the Field Health Services
Integrated Provincial Health Office of Northern Samar
Northern Samar, Philippines
01.1992 - 01.1995
- Company Overview: Philippines
- Supervises the proper implementation of the different public health programs in the province of Northern Samar
- Supervises health data collection for the entire province of N
- Samar, both from hospitals and public health programs, analyzes them and makes technical reports including the provincial annual health report
- Together with the different Health Program Managers of the Field Health Services, develops the Provincial Annual Health Plan, and monitors and evaluates the implementation of the plan
- Liaise and forms networks with other agencies
- Philippines
Senior Resident Physician
Northern Samar Provincial Hospital
Northern Samar, Philippines
01.1987 - 01.1991
- Examines and treats in and out-patients (all ages, all cases) of the N
- Samar Provincial Hospital with proper documentation
- Makes referrals to higher medical centers for patients who needs specialized care that cannot be provided by the Provincial Hospital
- Prepares schedule of activities of the medical staff, to include 24 hours duty, grand rounds, case and journal presentations, and morbidity and mortality conferences
- Supervises the work of the resident physicians
- Consolidates and analyze hospital statistical reports and submits them to the Chief of Clinics
Resident Physician
Northern Samar Provincial Hospital
Northern Samar, Philippines
01.1986 - 01.1987
- Under the supervision of the Senior Resident Physician and the Chief of Clinics, examines and treats in and out-patients (all ages, all cases) of the Provincial Hospital with proper documentation
- Refers patients to Senior Residents or Chief of Clinics for further evaluation and management of complicated cases
Education
Master of Health Profession Education - 10 units
National Teachers’ Training Center For The Health Profession
01.2000
Master of Public Health - University Scholar 2nd Semester
College of Public Health
01.1991
Doctor of Medicine -
University of Santo Tomas
01.1984
Bachelor of Science - Biochemistry
University of Santo Tomas
01.1980
Skills
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
- Flexible and adaptable
- Critical thinking
- Organizational skills
- Dependable and responsible
- Multitasking Abilities
- Excellent communication
- Computer skills
- Attention to detail
Accomplishments
- Led the transition to electronic medical record in the Provincial Hospital
- led the creation of the dialysis center of the Provincial Hospital
- Led the conversion of the Covid-19 ward to private rooms that generated additional revenues
- Led the implementation of the preparatory phase of the creation of Province-Wide Health System in the Philippines and was the first to accomplish it together with another province nationwide
- Awarded as the most outstanding health worker in Region 8 in 2023
Certification
- Certificate in Leadership in Health Care, National University of Singapore Yoo Lo Lin Medical School, Ongoing, 01/05/25
- OASIS Specialist – Clinical, Certified for the 4th time, 01/01/17
- Home Care Coding Specialist – Diagnosis ICD-10, Recertified for the 5th time, 04/01/20
- AHIMA Clinical Documentation Improvement, 06/01/17
Research
- Review of Community Health Financing Schemes in Selected Areas of the Philippines, Research Consultant, UNICEF, 05/01/97 - 07/31/97
- Evaluation of Mindanao Maternal and Child Health Project of UNICEF, Co-Investigator, UNICEF, 08/01/97 - 11/30/97
- Integrated Community Health Services Project (ICHSP), Special Studies, Member of the study team, Philippine Department of Health and Asian Development Bank, 07/01/99 - 12/31/99
Languages
North American English
Philippine National Language
Spanish
Technical German
Relevanttraining
- Leadership in Health Care conducted by National University of Singapore, 09/25/24 - 01/02/25
- High Quality Health Systems: Assessing Performance and Improving at Scale, Harvard T.H. Chan School of Public Health, 10/23/23 - 10/27/23
- Leadership and Development Program (LDP) to Accelerate UHC Implementation, 07/19/23 - 07/21/23
- Health in Emergencies, Training of Trainers, UNICEF, 11/28/22 - 12/02/22
- Webinar Training on Republic Act No. 9184 (Government Procurement Reform Act), Government Procurement Policy Board (GPPB), 10/18/21 - 10/22/21
- Universal Health Care Implementor’s Online Course, DOH, 04/01/21 - 06/30/21
Professional Examinations
- Philippines’ Physician Licensure Exam, Passed, 01/01/86
- United States Medical Licensing Exam Step 1, Passed, 05/08/02
- United States Medical Licensing Exam Step 2 CK, Passed, 09/16/02
- United States Medical Licensing Exam Step 2 CS, Passed, 09/01/05
Timeline
Chief of Hospital II/Medical Center Chief in an acting capacity
Provincial Health Office
02.2021 - 01.2024
Provincial Health Officer II
Provincial Health Office
08.2020 - 01.2024
Administrator
Medi Link Health Services LLC
10.2019 - 07.2020
Centralized Medical Coding Specialist
Almost Family Hospital Partnership Division
09.2014 - 08.2019
Assistant Administrator, Coder, Biller
Medi Link Health Services, LLC
02.2013 - 09.2014
Coding Consultant
Fazzi and Associates
12.2011 - 07.2012
Quality Assurance/Improvement Director, Coder and Biller
WeBridge Home Health Corporation
01.2008 - 02.2013
Quality Assurance/Improvement Director
Sure Care Home Health Corp
12.2006 - 12.2007
Home Health Services Consultant
NK Healthy Concepts Corporation
10.2005 - 07.2020
Quality Assurance/Improvement Director
Caring Professionals Home Care
03.2003 - 12.2006
Provincial Health Officer I
Provincial Health Office
01.2000 - 01.2001
College Secretary
University of the Philippines
01.1998 - 01.2000
Assistant Professor IV
University of the Philippines
01.1997 - 01.2000
Medical Specialist IV/Chief of the Field Health Services
Integrated Provincial Health Office of Northern Samar
01.1992 - 01.1995
Senior Resident Physician
Northern Samar Provincial Hospital
01.1987 - 01.1991
Resident Physician
Northern Samar Provincial Hospital
01.1986 - 01.1987
Master of Public Health - University Scholar 2nd Semester
College of Public Health
Doctor of Medicine -
University of Santo Tomas
Bachelor of Science - Biochemistry
University of Santo Tomas
Master of Health Profession Education - 10 units
National Teachers’ Training Center For The Health Profession