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Hoffman Mary 2016

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Hoffman Mary 2016

  1. 1. Mary Hoffman RHIT, CCS, CPC-H, COC AHIMA APPROVED ICD-10: Trainer and Ambassador Career Summary Extensive experience in the healthcare industry, with a focus on compliance, coding and recovery audits. Highly respected for expertise and exceptional communication skills with personnel and clients. Provides professional and succinct training resulting in a successful recovery audit program. Creates and delivers training and outreach sessions that are extensive and productive.  Selected as the keynote speaker for 80 rollout sessions to all provider types, held to educate providers and lessen disruption of their business due to recovery audits  Provided successful training to over 800 physicians, nurses and coders to validate coding  Known as an Industry expert—healthcare provider services  Experience in the healthcare industry, including claims auditing oversight, DRG validation, claims coding expertise, and Registered Health Information Technician AHIMA  Presented at the National Health Care Anti-Fraud Association (NHCAA) annual conference Employment History CGI Federal Inc., Health Compliance Business Unit 1995 - Present Director of Consulting Training Expert 2015 –Present  Leads the training component of the organization's ICD-10 initiative, to include training of clinical and non-clinical staff  Assists in development of system edits to identify coding vulnerabilities resulting in improper payments made on behalf of our payer clients  Develops and implements cost-effective training opportunities to support ongoing licensure requirements of professional staff and opportunities designed to further the development of administrative and clerical staff  Provides backup on-boarding and training to support the hiring needs of the business unit across all departments/divisions Director, Quality Assurance Training and Development 2010—2014  Provided overall accountability of the group’s focus on quality reviews which produced inter- rater-reliability, and maintained overall program excellence Director, Clinical Audit Department 2007- 2010  Overall accountability of the group’s profitability and growth, through meeting or exceeding revenue targets and contribution margins.  Maintained good client relationships and provide clear and succinct training Director, Recovery Audit Contractor (RAC) Program Region B 2008—2010  Provided leadership and guidance for the project, to manage the delivery of the RAC contract  Acted as the primary point of contact for CMS  Provided oversight and to maintain accountability for the staff, partners and deliverables of the contract Executive Consultant, Claims Validation Recoupment Project: 2005—2007 Commonwealth of Pennsylvania Department of Public Welfare (DPW)  Maintained on going contact with the DPW personnel and kept them notified of the status of work being done with weekly reports, facilitated meetings
  2. 2. Mary Hoffman Page 2  Organized and lead the activities of audit and programming team and coordinated with Project Director  Assured that required reimbursement policies and operational information were received  Assigned and scheduled appropriate tasks to staff. Coordinated training and documented ongoing communications with client  Monitored audit results, recoveries and reported any delays  Kept lines of communication open among all project participants and escalated critical issues to Senior Management  Took action on issues of non-compliance in quality Technical Team Lead/Senior Consultant, DRG Validation Audit Training Program 2000-2005  Projects: Foundations Health Services, TennCare BCBS, Regence Blue Shield (Seattle & Portland), Mountain State BCBS, Commonwealth of Pennsylvania Department of Public Welfare, BCBS Mississippi, CarePlus  Designed and presented a 3 to 5 day training program that encompassed an overview of DRGs, ICD-9-CM coding guidelines, case selection, DRG validation process, systems training on patented claims auditing software and online pre-selection module Senior Consultant, DRG Validation Demonstration Presentations 1997-2000  Projects: BCBS North Carolina, BCBS North Dakota, BCBS Oklahoma, Highmark BCBS, BCBS Minnesota, Tri-West Health Plan, Coventry, Humana  Compiled and presented a detailed analysis report of client data that would reveal overpayment of claims and recovery opportunities identified by our auditing software to potential clients Senior Consultant, DRG/APDRG Validation Audit Recovery/CMS-HCC Risk Adjustment 1995-2000 Projects: Medical Mutual of Ohio, BCBS North Dakota, BCBS Oklahoma, State of Montana Medicaid, BCBS Mississippi, Highmark BCBS, BCBS Michigan, CareFirst BCBS, BCBS Mississippi, TennCare BCBS, BCBS Western New York, and etc.  Performed DRG hospital auditing services (pre-selection of claims; medical record review and appeal process) for claims identified by our patented auditing software  Determined if the diagnostic and procedural information submitted for DRG reimbursement is substantiated by the documentation in the record Identified claims that were paid inappropriately Education, Certifications and Training AAS in Health Information Technology, Cuyahoga Community College BA in Communications, Cleveland State University Registered Health Information Technician (RHIT) Certified Coding Specialist (CCS) Certified Professional Outpatient Coder – Hospital (CPC-H) (COC) AHIMA Academy ICD-10-CM/PCS Certificate Holder - Approved Trainer and Ambassador Medical Severity Groups ICD-10-CM/PCS