Joy Hanford - 2-20-2014

Joy Hanford CPC, CCS-P
2054 Kimjo Dr.
Westminster, MD 21157
443-653-2175
Qualifications/Certifications:
 CPC: Certified Professional Coder from the AAPC, since March of 1996
 CCS-P: Clinical Coding Specialist – Physician Based from AHIMA, since October of 2000
 ICD-10 Certified Instructor by AHIMA as of August of 2012
 Cambridge Who’s Who Registry of Executive and Professionals as a leader in the Healthcare
Industry
School:
 University of North Florida: Continuing Education Classes for CPT and ICD9 coding in 1995
 Catonsville Community College (Accounting)
Work History:
Carroll Health Group (CHG) - Carroll Hospital Center
 May 6, 2014– Present
 Job Title: Director of Coding and Physician Education
 Responsibilities (Manage coding staff)
o Conducts random reviews of completed work to confirm staff competency and to ensure all
coders are completing coding assignment correctly.
o Recruits, interviews, hires, evaluates, trains staff, including making recommendations for
promotion and disciplinary actions.
o Monitors coder productivity
o Provides educational enhancements for each coder’s growth and retention
o Provides feedback to providers regarding trends and issues found by coders and collaborates
with each provider to effectively resolve coding aberrancies.
o Remains current with the latest healthcare technology and coding advisement through
reading available coding literature, attendance at seminars and in-services, internet research
and other educational resources for coding and reimbursement. Provides education to the
coding team as needed to help ensure others remain abreast of information.
 Responsibilities (Education)
o Designs and provides coding education and in-service training programs regarding
appropriate documentation and accurate coding to CHG. (Multi-specialty)
o Provides education to CHG regarding new ICD 9 diagnosis and CPT 4 procedures changes
as well as PQRS (Physician Quality Reporting System).
o Conducts new provider education/orientation.
o Ensures the appropriate dissemination and communication of all regulatory, policy and
guideline information to affected personnel.
 Responsibilities (Coding Liaison)
o Serves as a coding resource to providers, administrators, practice management and staff as
often as needed to address coding concerns, questions, and/or coding related billing
rejections or denials.
o Presents to the Performance Improvement & Compliance Committee to communicate
effectiveness of the coding program services including coding education plans, progress and
any issues that are being encountered where assistance is needed.
o Discusses coding issues with Compliance and other management staff in team meetings and
as needed to report issues and to discuss and develop plans for resolution.
o Works with Information Systems personnel and clinic departments to implement and/or
automate tools such as PQRS and EMR templates to help maximize technology development
to support physician practice operations.
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2054 Kimjo Dr.
443-653-2175
o Reviews diagnostic reports, i.e. CPT utilization patterns/trends and provides performance
feedback to management; validates issues and assists in the development of correction plans
as needed.
o Interacts with management on correction activities and coordinates the development and
implementation of strategies.
 Responsibilities – (Projects/other duties)
o On the ICD-10 implementation committee to ensure coder, provider, vendor, payor, clearing
houses, provider, patient accounting and staff readiness.
o PQRS implementation.
o Responsible for yearly budget justification of staff.
o Chair the Template Task Force committee for the creation/revision of EMR documentation
templates.
Practice Dynamics, Inc. - LifeBridge Health
 January 26, 2009 – May 5, 2014
 Job Title: Director of Coding and Reimbursement
 Responsibilities (Manage coding staff)
o Conducts random reviews of completed work to confirm staff competency and to ensure all
coders are completing coding assignment correctly.
o Recruits, interviews, hires, evaluates, trains staff, including making recommendations for
promotion and disciplinary actions.
o Provides coverage when and where necessary so that each practice has constant reliable
coding service permitting accomplishment of coding within acceptable time frames.
o Provides educational enhancements for each coder’s growth and retention.
o Ensures that all production and quality targets and departmental goals are met (charge entry
lag time and accuracy).
o Evaluates staffing resources against coding inventories to determine PDI staffing is
appropriate for workload requirements.
 Responsibilities (Manage quality analysts)
o Manages the Ingenix (now OptumInsight) Claims Manager program to ensure appropriate
resolution of Medicode edits (front end coding edits) by the Quality Analysts in accordance
with policy, regulations, reporting of production, efficient workflow management and analysis
of trends.
o Provides feedback to the practices regarding trends and issues and collaborates with practice
and billing staff to effectively resolve coding edits.
o Review claims denials pertaining to coding and medical necessity issues and implements
corrective action plans, such as educational programs, to prevent similar denials from
recurring.
o Provides feedback to practice management regarding coding edits and denials as early as
possible in the documentation and coding process and educate providers and practice staff
regarding coding requirements.
o Collaborate with practice management and providers to correct coding practices to help
prospectively prevent initial denials and to retrospectively fix denials and prevent recurrence.
o Produces, disseminates, analyzes and presents reports generated from Claims Manager
(coding edits) to the practices. Uses reports to identify and support improvement initiatives.
o Serves as the Liaison between PDI and LBH Practices regarding Claims Manager issues.
 Responsibilities (Education)
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2054 Kimjo Dr.
443-653-2175
o Designs and provides coding education and in-service training programs regarding
appropriate documentation and accurate coding to all customers. (Multi-specialty)
o Provides focused coding and compliance education to faculty, administration, clinic staff and
billing staff in response to coding and compliance reviews to help ensure that compliance is
achieved and maintained. Collaborates and coordinates with the director of compliance.
o Provides annual education to customers regarding new ICD 9 diagnosis and CPT 4
procedures changes as well as PQRS (Physician Quality Reporting System). Conducts new
provider education/orientation.
o Remains current with the latest healthcare technology and coding advisement through
reading available coding literature, attendance at seminars and in-services, internet research
and other educational resources for coding and reimbursement. Provides education as
needed to help ensure others remain abreast of information.
o Ensures the appropriate dissemination and communication of all regulatory, policy and
guideline information to affected personnel.
 Responsibilities (Coding Liaison for Lifebridge Health)
o Serves as a coding resource to providers, administrators and practice management staff in
the monthly chief billing meetings and as often as needed to hear coding concerns, discuss
financial performance, review coding related billing rejections.
o Presents reports in Revenue Cycle Committee to communicate effectiveness of the coding
program services including coding education plans, progress and any issues that are being
encountered where assistance is needed.
o Discusses coding issues with the COO and the Compliance Director and other management
staff in team meetings and as needed to report issues and to discuss and develop plans for
resolution. Tracks and resolves issues, triages coding questions and provides research and
facilitates resolution of daily issues.
o Works with Information Systems personnel and clinic departments to implement automation
tools such as electronic health record, e-prescribing and other tools as needed to help
maximize technology development to support physician practice operations.
o In collaboration with the compliance department and LBH practices implements new
programs and maintains existing programs such as PQRI, with particular emphasis on any
programs or tools that will help increase the provider's reimbursement and income. Assists in
the development of ProFormas for new business.
o Reviews diagnostic reports, i.e. CPT utilization patterns, and provides performance feedback
to management; validates issues and assists in the development of correction plans as
needed.
o Interacts with management on correction activities and coordinates the development and
implementation of strategies.
o Achieves goals identified for but not limited to coding denial rates, PDI profitability, cash flow
and Claims Manager edits.
o Stays aware of factors affecting financial performance such as charge transactions and
determines the impact of the coding department on budget performance.
 Responsibilities – (Projects/other duties)
o On Lifebridge Health’s ICD-10 implementation committee to ensure vendor, payor, clearing
houses, provider, patient accounting and staff readiness.
o Part of the EMR/charge interface implementation for each practice to ensure compliant
charges.
o Implemented NCD requirements with IS and Lifebridge Health practices.
o Responsible for yearly budget justification of staff.
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2054 Kimjo Dr.
443-653-2175
 Responsibilities (Director of patient accounting for Anesthesia, Surgical Oncology, Cardiac
Catheterization Group, Interventional Radiology, Pathology and Cardiology.)
o Oversees a billing team dedicated to revenue cycle activities for assigned specialties to
ensure that acceptable billing and cash flow levels are maintained. Responsible for all
aspects of the operations unit including billing edits, claims processing, payment posting,
account recovery and customer service. Assists with overall business planning, budgeting,
trend analysis and evaluation of the department’s services.
Erickson Health Medical Group:
 November 2005 – January 9, 2009
 Job Title: Director of Coding and Compliance
 Responsibilities:
o Conducted yearly compliance chart audits of all providers in 18 medical centers
o E/M trending analysis for all 18 medical centers
o Conflict of Interest Audits
o CLIA Audits
o Credentialing Audits
o New provider Medicare & E/M orientation training
o New provider training on PQRS (Physician Quality Reporting System)
o New provider training on E-Prescribing
o New provider training on Erickson Advantage, specifically Risk Adjustment. (Medicare
Advantage product)
o Conducted new provider audits to monitor compliance and provide additional education and
training if necessary
o Conduct new provider E/M Bell Curve trending analysis and provide additional training if
necessary.
o Educational training on Medicare and Coding updates/revisions
o Publish a Quarterly Coding and Compliance Newsletter
o Risk Adjustment (Medicare advantage) audits
o Implemented weekly visits with the Central Billing Office (CBO) to correct billing errors,
denials, and edits.
o Assisted with Centricity (Electronic Medical Records) physician documentation forms to
approve Medicare Compliant documentation templates
o Yearly training on CPT/ICD9 changes
o Supervise coding staff
o Compliance Budget
o Multi-specialty coding
o Coding and Compliance resource to18 Medical Centers.
o Maintains a Coding and Compliance websites on PQRI, Risk Adjustment, Coding resources,
Competitive Acquisition Program, and Physician Peer Review
o PQRI now PQRS (Physician Quality Reporting System): Implemented the CMS PQRS
initiative for all 18 medical centers. Erickson Health Medical Group will receive 2% of all
physician part B services billed in 2009, 1.5% in 2008 and received incentive payment in
2007.
o Implemented CMS E-Prescribing initiative: This project implemented an E-prescribing
program to report to Medicare the usage of E-Prescribing in 2009 for 18 medical centers.
Erickson Health Medical Group (EHMG) will receive a 2% of all physician part B services
billed for each provider who successfully reports E-Prescribing usage. It was estimated that
EHMG will receive a half a million dollars in bonuses for 2009.
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2054 Kimjo Dr.
443-653-2175
o Implemented and transitioned out of CAP (Competitive Acquisition Program): CMS program
to obtain Part B drugs at no cost.
o Implemented and developed a Physician Peer Review policy, website for reporting, and
development of a Peer Review Committee
o Applied for the Electronic Health Record Demonstration initiative from CMS which positioned
Erickson to receive a monetary bonus payment of $590,000 over the next 5 years.
American Express Tax & Business Services (Now RSM McGladry)
 January 2005 – November 2005 (left during the transition to work for Erickson)
 Job Title: Healthcare Coding and Compliance Manager
 Responsibilities:
o Conduct compliance audits.
o Educational training sessions on E/M documentation, compliance, PATH (Physicians at
Teaching Hospitals), Incident-to, Shared visits, as well as specialty specific training.
o Physician compliance, billing, coding and reimbursement consultant.
o Supervise coding staff
o Published a Quarterly Coding and Compliance Newsletter
o Healthcare consultant
University Physicians, Inc.
 July 6, 1999 – January 26, 2005
Job Description: Senior Compliance Auditor
Responsibilities:
o Audit Departments of the University of Maryland’s school of Medicine. Departments audited:
Surgery (Multi-specialty by division), Anesthesia, Shock Trauma, OB/GYN, Cancer Center,
Interventional Radiology, Cardiology, Orthopedics, Ophthalmology, Pathology, Dermatology,
Medicine (multi-specialty), Neurology, Neurosurgery, and Radiation Oncology.
o Educate non-compliant physicians that required training after an unfavorable compliance
audit.
o Conduct the New Physician/Fellow/Resident/Coder Training on Introduction to
Compliance/E&M documentation and Teaching Physician regulations.
o Assisted in the creation of a compliance audit database. In addition, wrote the user manual
for the Audit Compliance database (192 pages) – this database has now progressed to MD
Audit.
o Coding and compliance resource to all departments.
o Experience with PATH (Physicians at Teaching Hospitals – CMS/OIG audit) audits and
experienced the auditing and reporting side of the OIG.
o ICA (Institutional Compliance Agreement) experience.
o Editor of UPI’s monthly Compliance Newsletter
Johns Hopkins
 June 14, 1998 – July 5, 1999
Job Description: Coder/Team Lead
Responsibilities:
o Code Anesthesia and Intensive care charges i.e. E/Ms, Anesthesia & Surgical CPT codes for
multiple specialties.
o Educate physicians on proper E/M documentation, and/or coding aberrancies.
o Work rejections, Medicode edits from the TES system, Post charges, and charge corrections
as well as payment posting.
o Educate staff on coding issues and Medicode edits.
o Resource for coding and collection staff.
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2054 Kimjo Dr.
443-653-2175
Nemours Children’s Clinic
301 Nira St.
Jacksonville, Fl 32207
(904) 390-3696/3600
 August 30,1990 – March 13,1998
Job Description: Coder
Responsibilities:
o Code Surgery & Anesthesia CPT & ICD9 for multiple specialties.
o Code E/M for critical care patients
o Code E/M office, outpatient and inpatient for Pulmonary, Allergy, GI and Infectious Disease
clinics
o Obtain Pre-Certifications for surgeries
o Post charges
o Created templates for E/M documentation
o Register patients
o Educated physicians current with revision, deletions or additions to CPT/ICD9 codes
o Consult with physicians on coding problems.
o Created encounter forms.
Software Application Skills:
 Medical Manager
 Practice Partner – Billing and EMR
 Cerner – EMR
 Centricity – Billing and EMR
 Practice Plus
 HCS billing software
 IDX billing software – GE Centricity
 PCS (paperless collection system)
 Encoder Pro
 Correct Code Check
 Claims Manager – Optum Insight
 TES (transaction editing system)
 MModal – voice recognition software & ICD-10 documentation assistant & CAC (Computer Assisted
Coding)
 Dragon – Nuance – voice recognition software
 GroupWise and Outlook
 Microsoft Excel, Word, Access, & PowerPoint
 Some training in T-Sequel Server.
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Joy Hanford - 2-20-2014

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