Karen Phillippi, RN BSN MBA

CEO

Columbus, Ohio, United States25 yrs 8 mos experience

Most Likely To SwitchHighly Stable

Key Highlights

Proven track record in Medicare Advantage markets.
Expert in risk adjustment and quality improvement.
Leader in building scalable clinical operations.

Stackforce AI infers this person is a Healthcare Executive specializing in clinical operations and risk management.

Contact

Skills

Core Skills

Executive ManagementClinical OperationsRisk AdjustmentQuality ManagementHealth Services ManagementCase ManagementUtilization Management

Other Skills

AnalyticsCMSCare managementChange ManagementClinical Documentation Improvement ProgramClinical OutcomesCoding operationsCross-functional Team LeadershipData AnalysisDelegate ManagementDisease ManagementHCC CodingHealth Plan OperationsHealthcare ReimbursementHedis

About

Senior healthcare executive with deep experience leading enterprise clinical operations across risk adjustment, Quality/Stars, HEDIS abstraction, MSO operations, and global coding teams. Proven track record of building scalable programs in prospective review, concurrent coding, clinical documentation improvement, and retrospective review. Known for transforming performance across Medicare Advantage markets through strategic planning, operational execution, provider engagement, and data-driven decision making. Skilled in leading global and stateside teams, improving RAF accuracy, strengthening Stars quality, and delivering financial and clinical outcomes. Passionate about operational excellence, accountable leadership, and partnering with payors and provider groups to improve patient care and organizational performance.

Experience

Agilon health

2 roles

SVP, Centralized Clinical Operations

Promoted

Feb 2024 – Present · 2 yrs 1 mo

Summary:
Executive leader overseeing enterprise clinical operations across risk adjustment, Quality/Stars, HEDIS abstraction, MSO operations, patient experience, and global clinical teams. Expanded scope from VP to SVP while maintaining full ownership of risk adjustment performance and adding quality and delegated operations.
Highlights:
Lead all centralized clinical operations, including risk adjustment, Quality/Stars, HEDIS abstraction, and MSO workflows.
Oversee global and U.S.-based teams in coding, prospective review, provider operations, and clinical documentation.
Direct Stars strategy, HEDIS execution, standard and non-standard data submissions, and provider performance improvement.
Partner with technology teams and vendors to enhance documentation, analytics, workflow tools, and concurrent review programs.
Align medical directors, quality leaders, coders, and clinical operations to strengthen accuracy, compliance, and outcomes.

Executive ManagementMedicare AdvantageStarsPopulation HealthCross-functional Team LeadershipCMS+14

Vice President, Risk Adjustment

Jul 2021 – Feb 2024 · 2 yrs 7 mos

Summary:
Enterprise leader building and scaling the organization’s end-to-end risk adjustment platform across 30+ Medicare Advantage markets. Developed prospective, concurrent, retrospective, and automated suspecting programs now overseen within the SVP portfolio.
Highlights:
Built and executed enterprise risk adjustment strategy spanning all review types.
Established a prospective review program with 150+ physician reviewers and launched automated suspecting.
Scaled a 250+ coder workforce across global and U.S. operations.
Led development of coding standards, documentation guidelines, tip sheets, and enterprise policy.
Directed analytics, reporting, and market support for coding accuracy, provider engagement, and RAF performance.
Managed code submission, reconciliation, and validation with payor partners.

Executive ManagementMedicare AdvantageStarsPopulation HealthCross-functional Team LeadershipCMS+13

Anthem, inc.

Regional Vice President, Medicare Stars, Quality Management and Risk Adjustment Performance

Dec 2020 – Jul 2021 · 7 mos · Columbus, Ohio, United States

Summary:
Led Stars, HEDIS quality, and risk adjustment performance across an eight-state Medicare Advantage region. Drove provider engagement, member outreach, performance improvement, and data-driven quality initiatives.
Highlights:
Directed regional quality, Stars, and risk adjustment strategy across 8 states.
Managed practice consultants, analysts, and program managers executing performance improvement plans.
Developed provider scorecards, reporting packages, and quality targeting models.
Improved provider and EMR data transmission for Stars and risk adjustment.
Delivered measurable improvements in documentation accuracy, gap closure, and provider engagement.

Executive ManagementMedicare AdvantageStarsPopulation HealthCross-functional Team LeadershipCMS+13

Medigold

Vice President, Health Services

Nov 2016 – Dec 2020 · 4 yrs 1 mo · Columbus, Ohio

Summary:
Executive leader overseeing risk adjustment, Stars/HEDIS quality, utilization management, case management, and delegated oversight for a Medicare Advantage plan.
Highlights:
Led enterprise risk adjustment strategy including in-home assessments, CDI, audit oversight, and point-of-care tools.
Directed Quality/Stars programs, improving plan rating from 3.5 to 4.5 Stars in two years.
Oversaw UM/CM operations ensuring compliance with CMS and NCQA requirements.
Implemented Lean management and accountability models, improving engagement and operational efficiency.
Developed NCQA-aligned delegation oversight program supporting network and contracting activities.

Executive ManagementMedicare AdvantageStarsPopulation HealthCross-functional Team LeadershipCMS+14

Mount carmel health system

4 roles

Regional Director of Case Management

Promoted

Dec 2012 – Nov 2016 · 3 yrs 11 mos · Columbus, Ohio

Summary:
Led case management, utilization management, and social work operations across five hospitals, driving strategic and operational improvements in care transitions and regulatory compliance.
Highlights:
Directed UM/CM/social work operations across five hospital campuses.
Reduced case management denials by 70% and readmissions by 4%.
Built a robust utilization review program reducing revenue loss and improving compliance.
Strengthened workforce development through new training programs, competency assessments, and orientation systems.

Executive ManagementMedicare AdvantagePopulation HealthCMSCare managementClinical Documentation Improvement Program+8