Risk Adjustment Vice President
Resume:
Angela Hickman
Klamath Falls, OR *****
**************@*****.***
Summary
Angela m. Hickman has over 23 years of experience in healthcare, including, but not limited to, Risk Adjustment KPI & Metric Testing, Clinical Quality Metrics & Analysis, Clinical Workflow Management, Strategic Implementation Of EEHR& Is/It Initiatives, Provider Proficiency & Accuracy In Coding for CMS-HCC Requirements, HHS-HCC Commercial Exchange Documentation And Coding For Risk Adjustment. Angela has spearheaded complicated, multi-dimensional and multi-domain projects, requiring a high degree of knowledge, skills, and proficiency with repeated success. Angela receives recognition as a pioneer in the healthcare industry for creating Best Practices in her successful advisory and guidance to organizations through notably the most significant changes in healthcare's history.
Angela directs and develops Corporate Compliance Programs' Policies & Procedures, Clinical Documentation Improvement Programs, and Legal & Ethical Uses of Electronic Health Records to Support the Continuity of Care for Patients. Angela's acumen and experience have positioned her in the industry as someone sought after to pioneer multi-faceted and complex implementation. Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
VP RA-HCC CDI & Enterprise Compliance
T-Medicus LLC - Indianapolis, IN
January 2017 to Present
• Designed & Managed the Implementation of the Risk Adjustment Service Line for delivery by coding leaders globally.
• Implemented a client expectation tracking tool and dashboard to monitor the organization’s promise to exceed client expectations, showing a 22% increase in client satisfaction scores.
• Ensured successful delivery of operating results as measured by revenue and appropriate margins; the most critical measurement was maintaining high-quality results.
• Designed and managed a successful workflow for onboarding and implementing new clients.
• Oversaw and contributed to developing and implementing global policies and procedures to assure precise and consistent standardized operations of coding areas while encompassing departmental and organizational needs.
• Maintained metrics on all quality measures, training/development, and productivity standards.
• Created and Incorporated a Program for Leadership Development for Management Staff
• Developed all policies and procedures consistent with the regulatory bodies such as CMS, AHA, AHIMA, NCQA, and the OIG specific to the Coding Department. Vice President of Coding Compliance & Operations
Access Healthcare
April 2017 to August 2019
• Leadership and development of service delivery models to capture accurate documentation & coding for physicians.
• Developed a new Program to implement the first Revenue Integrity Department for the Organization responsible for Virtual Global Initiatives.
• Ensure successful delivery of operating results as measured by revenue, appropriate margins, and quality.
• Ensure successful implementation of new clients.
• Oversee the development and implementation of global policies and procedures to ensure precise and consistent operation of coding areas while encompassing departmental and organizational needs.
• Maintained metrics on all quality measures, training/development, and productivity standards.
• Oversee the development and implementation of a global coding education program for all coding staff and business development staff,
• Remain abreast of coding and medical records development, mainly when applied to coding, reimbursement, and clinical database developments/changes.
• Strengthen and grow coding capabilities the in the US, India, and the Philippines to meet client and market demand
• Significant international and domestic travel as needed.
• Responsible and accountable for internal control implementation and performance within their areas of ownership/responsibility.
• Ensured proper change management protocol was being incorporated by all team and staff Vice President RA-HCC Strategy & Business Development MIRAMED GLOBAL SERVICES
2015 to August 2017
• Launched New Business Line for Risk Adjustment & HCC Coding in line with Mira Med's Company Strategy for continual growth
• Developed a 21 Module Training Program conducted offshore for 750 coders and auditors in India and the Philippines'
• Spent eight weeks in India for the Kickoff training of our RA service line & 4 weeks in the Philippines
• Conducted all coder training on ICD-10-CM/PCS and Risk Adjustment Methodologies that included Version 22 CMS-HCCs & HHS-HCCs Code sets and the processes for Data Validation onsite and virtually
• Incorporated a hybrid training model for offshore coding education through the virtual, live-streaming web-based training
• Led communication task force for connecting onshore and offshore coding staff, which helped the coders grow exponentially
• Applied Change management and Cultural Awareness techniques in transitioning coders from traditional ICD-9/ICD-10 coding to the new HCC coding methodology
• Leveraged virtual capabilities allowing collaborations between onshore and offshore coders, auditors, and managers
• Developed consulting workflow for provider offices and health plans
• Optimized the use of the EMR for physicians allowing "flags" to show in the note whenever critical documentation hit an edit, such as incomplete documentation, to support a diagnosis of conflicting documentation from the use of the copy/paste function
• Developed Best practices and wrote policies to align with Risk Adjustment Regulatory requirements Project Manager for ICD-10-CM/CMS Implementation
Boston Medical Center - Boston, MA
January 2013 to December 2015
ICD-10 Project Manager for the implementation of the ICD-10
• Project Managed Developed ICD-10-CM/PCS Physician Trainings for 44 different specialty & sub- specialty groups focused on documentation capture within Epic, ensuring robust documentation to support ICD-10 coding and other initiatives.
• Trained all MDS and surgeons Enterprise-wide on ICD-10 concepts via scenario-based training within the Epic clinical record
• Possessed proficiency with the Clinical Documentation (CLINDOC) application module for EPIC EMR system as a Power User/Physician Support for capabilities to address process workflow requirements
• Reviewed 3,200 established Smart Tools in Epic, validating accuracy and completeness while assigning priority to specialties most impacted, especially those highest risk specialties fo,r immediate remediation
• Created 430 smart phrases and smart texts for the provider community and templates that drive a compliant medical record.
• Presented to all 44 physician specialties
• Utilized change management techniques to support clinicians in the process of making the difficult transition
Project Manager for ICD-10CM/PCS Implementation
Harvard Medical Faculty Physicians at Beth Israel Deaconness Medical Center - Boston, MA April 2012 to December 2015
• Supported CFO as ICD-10 Project Manager and ICD-10 SME for Financial Operations and for HMFP's Compliance Department by the organization’s mission of maintaining high standards and allowing collaboration with patients through imputing effective interpersonal relationships amongst all stakeholders
• Developed ICD-9 to ICD-10 Superbill map from my own ICD-10 Database of Physician Documentation Requirements
• Organized the opportunities for exposure and marketing when asked to Present for HBMA's National Conference in Las Vegas in 2014. I proposed to the CFO to share our project methodology, tools, and techniques and to openly discuss Lessons Learned to date in our implementation work
• This presentation also provided a marketing platform for HMFP to share Lessons Learned from InduIndustry-wide ore. ICD-10-CM/PCS Go-Live
Project Manager responsible for overseeing the successful implementation of strategic healthcare initiatives and constructing the teams that need to be accountable for the end-to-end transition. Implemented clinical documentation improvement processes for various organizations and practices and provided training for over 5,9MDsD's and Surgeons on ICD-10-CM/PCS in 2015. Project Manager for ICD-10-CM/PCS Implementation
Massachusetts Institute of Technology Medical Center - Cambridge, MA February 2012 to December 2015
ICD-10 Project Manager for the implementation of the ICD-10
• Compliant industry standards put forth by the OIG that contains pertinent policy and procedure updates critical to the transition
• Best practices as determined by CMS, top Industry Leaders, and the Organizations they represent
(MGMA, AHA, HFMA) to be in line with their unique infrastructure and culture Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, MA ICD-10 Project Manager for the implementation of the ICD-10
• Partnered with HMFP'S CFO to develop strategies for the comprehensive assessment of current provider workflows
• Developed ICD-10 project plans for each of the 13 multi-divisional medical specialty departments
• As a result of the CMS one-year delay, partnered with the Compliance Officer, re-purposed strategically to address any current deficiencies physicians were having with the documentation and the coding of the patient record
• Utilized the Hayes Management Auditing tool that HMFP was already using internally to conduct audits on the physicians & surgeons, inpatient, and outpatient Director Of Clinical Programs & Strategy
THE ZICA GROUP, INDPLS., IN
January 2015 to April 2015
Direct teams responsible for operationalizing Programs within the organizations, consistent with each client's vision, through the deployment of teams with the necessary skill set, knowledge,e, and experiences to ensure the client receives a service beyond client expectations. Utilizing standard program and project management techniques and tools, the following highlight specific areas:
• Quantitatively and qualitatively drive decision-making processes
• Workflow strategy and efficiency
• Populations Health Management via strategic planning and tracking
• Collaborate and support Clinically Integrated Networks (CINs)
• Meaningful Use of EHRs through optimization for reporting quality measures required by state and national laws
• Care Management Programs focused on the patient and the provider-patient relationship
• VBP contracts and Risk-Stratifications, physician quality reporting (PQRS), and Change Management Processes that facilitate the vibrancy and efficacy needed for organizational success Senior Management Consultant
CULBERT HEALTHCARE SOLUTIONS, WOBURN, M - Woburn, MA April 2011 to January 2015
Culbert acknowledged her for four consecutive years as the 2nd Top Consultantnsultain in 2012, 2013 and 2014, and 2015.
• Honored to receive The Presidents Club Award for an employee's outstanding ability to consistently go beyond expectations for the client. The award is based on the client’s satisfaction after the engagement and their report.
The following organizations represent a detailed picture of some of the client engagements I was responsible for and accountable for while working for CHS: Senior Management Consultant
• Collaborated with EVMS revenue cycle and compliance leadership on evaluating output from Allscripts ICD-10-CM Problem Mapping Tool in Allscripts.
• Developed the project to address the inaccuracies found from the initial impact assessment by addressing the gaps and re-mapping the tool not only to be accurate but to increase reimbursement and reduce denials for unspecified coding and incomplete coding when more than one code is required
• Engaged physicians in the conversation around the importance of compliance for ICD-10.
• Risk analysis was conducted, and mitigation strategies were developed and detailed should any of the highhigh-risk medimedium-riskms pose a threat to the successful consummation of the project and presented to all stakeholders the Final Report Executive Summary complete with additional recommendations on areas to improve.
Weill Cornell Medical School and New York Presbyterian Hospital, New York City, NY Senior Management Consultant for Epic Go-Live
• Managed and Facilitated real-time Project oversight with the transition to the Epic electronic health record (EMR) while serving as SME and Support for Weill Cornell and New York Presbyterian Hospital throughout go-live and six months post-go-live
• Met with providers to assess the utilization of EHR in optimizing functionalities to meet differing departmental needs.
• Served as the coding and documentation content expert on the optimization of the EMR using Smart tools in Epic
• Created twenty-five templates specific to each department, namely Orthopedic Surgery (Adult & Pediatric), Oncology, Hematology, and Cardiothoracic Surgery & Cardiology Interventional Procedures.
• Conducted individual department meetings to prioritize those high-risk areas for immediate contingency.
• Educated and Updated on all CMS Regulatory changes and the direct impact each of those had on critical areas within the organization.
• Constructed & Formulated all metrics within a Visual dashboard, available for their continuing and real- time access on the organizations' Intranet using Tableau.
• Held stakeholder meetings to review the assessments' results and highlight the gaps found to be the most critical to the organization's success.
Coding Auditor
Duke University Department of Surgery - Durham, NC April 2011 to June 2012
Auditor & Senior Management Consultant
• PRMO Revenue Cycle Assessment through to implementation of a central billing office and several workflow re-designs
• Project managed and Performed 500 record audits composed of all surgery departments following the organization's conversion from GE to Epic suite of ambulatory EHR and practice management applications
• Presented Physician Audit results to the Department of Surgery and conducted all training in specific areas where the physicians' showed deficiency and noncompliance
• Accountable for providing weekly updates to the project status directly to the COO & CFO, and The Chief of General Surgery
• Responsible for the successful strategic development of the plan of action for the re-design of current state physician workflows
• Established a Taskforce to manage a formal ongoing, internal education program with the coding and billing departments so that through the internal Pipeline Program, the current employees could train in coding from other departments, and continued development of the current coding staff would be enhanced.
• Completed Executive summary and presentation of the project scope results to the department and the board
Senior Consultant
BLUE & CO., LLC - Indianapolis, IN
January 2009 to April 2011
Oversaw auditing for hospital and physician practices, clinical documentation training, and improvement via developing CDI programs for clients. Key projects included were but not limited to: Good Samaritan Hospital, Indianapolis, IN
Senior consultant & Auditor
• Conducted ICD-10-CM/PCS documentation audits, assisting hospitals and physician practices with the transition to new ICD10 documentation requirements
• Monitored coding and billing activities, ensuring compliance with medical record ICD-10 protocols.
• Developed a 3-tier training curriculum with stakeholders divided by C-suite, physician/clinician, and coding/billing training groups.
• Presented the training to 26 Rural Health Organizations and Physician groups.
• Supported the organization's goal of consistent, complete, and accurate coding and reimbursement by developing additional coding tools and resources
• Worked with Clients and their respective stakeholders to create the project plans for implementing ICD-10 and advised on areas for improvement in the physician documentation with accurate assigning of codes and a complete medical record that withstand any audit.
• Ensured that processes engaged all stakeholders in a collaborative, unified vision, and consummation of the transition from ICD-9 to ICD-10
SENIOR CONSULTANT
CIPROMS - Indianapolis, IN
August 2004 to December 2008
ICD-10-CM/PCS
• Conducted provider training in multiple organizations, from large and small academic medical centers to single-physician practices.
• Presented ICD-10-CM/PCS to varied organizations, including HBMA, IRHA, AAPC, and NAPPP
• Facilitated live streaming webinars for national organizations, including NAPPP, and presented to 26 hospitals in IRHA, targeting c-suite staff
• Assigned diagnosis and procedural codes within the patient’s medical record
• Improved reimbursement and billing, statistical reporting, resource usage, and search by maintaining high accuracy.
• Developed and ICD-10 crosswalk, from ICD-9 to ICD-10 codes specific to Emergency Room Physician ST. FRANCIS HOSPITAL, INDIANAPOLIS, IN
EMERGENCY DEPARTMENT AND CLINICAL SPECIALTIES AUDITOR
• Coded and audited charts for physician specialty practices, including orthopedics, cardiology, and OB/ GYN
• Used E/M auditing tool to assign appropriate levels for each physician encounter while problem-solving claim denials to correct and ensure
Education
Master's in Health Information Management
COLLEGE OF ST. SCHOLASTICA - Duluth, MN
2018 to Present
Associate in Allied Health
MEDTECH COLLEGE - Indianapolis, IN
January 2005 to April 2006
Bachelor's in Psychology
PURDUE UNIVERSITY - Indianapolis, IN
January 1989 to August 1994
Bachelor's degree in Psychology
Skills
• ICD-10
• HIPAA
• Microsoft Excel
• Microsoft Powerpoint
• Microsoft Office
• Visio
• Tableau
• Strategic planning
• ICD-9
• Agile
• SDLC
• Analysis skills
• Waterfall
• Jira
• Employee evaluation
• HCPCS
• Typing
• Windows
• Mentoring
• Microsoft Access
• Microsoft Word
• Medical office management
• Employee relations
• Customer service
• Meditech
• Leadership
• Communication skills
• Spanish
• Microsoft Outlook
• Root cause analysis
• Business requirements
• NCQA standards
• Business Analysis
• SharePoint
• Medical coding
• Documentation review
• ICD coding
• Project management methodology
• Risk analysis
• Program management
• Data warehouse
• Curriculum development
• CPT coding
• Quality assurance
• EMR systems
• Physiology knowledge
• Earned value management
• Office manager experience
• Content management systems
• User acceptance testing
• Organizational skills
• Project management
• Project management
• Data management
• Data management
• HEDIS
• Analytics
• Revenue cycle management
• Operations management
• iOS
• Financial acumen
• Medical terminology
• Teaching
• Healthcare management
• Medicare
• Benefits Administration
• Negotiation
• Public relations
• Change Management
• Project Implementation
• Epic
• Requirements Gathering
• Process Improvement
• Risk Adjustment Methodologies (9 years)
• Cerner
• EHR systems
Links
http://www.linkedin.com/in/angelahickman1
Awards
The Presidents Club
October 2014
The top 5 out of approximately 200 consultants receive this prestigious award. The Presidents Club
October 2014
The top 5 out of approximately 200 consultants receive this prestigious award. The Presidents Club
October 2015
The top 5 out of approximately 200 consultants receive this prestigious award. Certifications and Licenses
Certified Professional Coder (CPC)
Present
AHIMA Approved ICD-10-CM/PCS Trainer & Ambassador
Present
Certified Emergency Medicine Coder
Present
Certified Professional Medical Auditor
Present
Medical Coding Certification
PMP
Assessments
Supervisory Skills: Directing Others — Expert
August 2019
Motivating others through feedback to identify improvements or corrective actions. Full results: Expert
Electronic Medical Records Knowledge — Expert
September 2019
Knowledge of EMR data, associated privacy regulations, and best practices for EMR use. Full results: Expert
Management & Leadership Skills: Impact & Influence — Highly Proficient December 2018
Measures a candidate's ability to adapt their leadership style to accomplish goals using rational or emotional appeal.
Total results: Highly Proficient
Electronic Medical Records: Best Practices — Expert October 2019
Knowledge of EMR data, associated privacy regulations, and best practices for EMR use. Full results: Expert
Electronic health records: Best practices — Expert November 2020
Know EHR data, associated privacy regulations, and best practices for EHR use. Total results: Expert.
Basic spreadsheets with Microsoft Excel — Highly Proficient September 2019
Measures a candidate's knowledge of basic Microsoft Excel techniques, including sorting, formatting, and filtering columns or rows.
Total results: Highly Proficient
Indeed Assessments provide skills tests not indicative of a license, certification, or continued development in any professional field.
Groups
PROJECT MANAGEMENT INSTITUTE CENTRAL INDIANA CHAPTER, Member Present
AHIP, MEMBER
Present
MGMA, MEMBER
Present
HFMA, MEMBER
Present
HBMA, MEMBER
Present
AMA, MEMBER
Present
AAPC, MEMBER
AHIMA, MEMBER/AMBASSADOR
Present
AMERICAN ACADEMY OF OPHTHALMOLOGY EXECUTIVES (AAOE), Present
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE (ASRM), Member (ID: Present
HEALTH CARE COMPLIANCE ASSOCIATION (HCCA), Member (ID: Present
Publications
Coding and Compliance ICD & DSM for Clinicians
http://Amazon.com
January 2017
Additional Information
Behavioral Health Solutions: Reference and Project Descriptions for Angela Hickman March 9, 2016
Behavioral Health Solutions (BHS) is a national consulting firm focusing on health and information technology for the health and human services industry. BHS is owned and led by a clinical psychologist with HIT, executive leadership, and project management expertise. Primarily retained for change management and a variety of clinical training needs, BHS specializes in the following types of projects: Electronic Health Record Selections, Implementations, and Optimizations; Information Technology Assessments; Clinical Coding and Documentation Training; Change Management and Organizational Transitions, Meaningful Use, and PQRS Program, and regulatory Compliance program establishment, evaluation, and enhancements.
BHS retained Angela Hickman, BS, CPC, CPMA, CPCO, CEDC, AHIMA ICD-10-CM/PCS Trainer to assist on several projects and in an advisory capacity for her expertise in the medical industry, her coding and documentation certifications, her work with IHIMA, AHIMA, and her recent work with Harvard, MIT, and Boston-Medical’s ICD-10 Implementations and compliance projects. Angela brought her medical knowledge and experience in facilities that had integrated-care environments and who were retained by BHS for projects.
Descriptions of her work, deliverables, and expertise include: 1. 2015-2016: Co-Author with BHS: “Coding and Documentation Compliance for the ICD and DSM: A Comprehensive Guide for Clinicians.” In addition to serving as a co-author, Angela’s primary responsibility for this textbook is to author the chapter on SNOMED CT codes and provide feedback on ICD-10 CM Coding and documentation compliance issues are primarily written by BHS. Anticipated publishing date: Fall 2016 by Routledge, Taylor, and Francis. 2. Spring 2015: Home of the Innocents, Louisville, Kentucky: BHS was retained to oversee HOTI’s ICD-10/DSM-5 transition in the Spring of 2015. HOTI is a multi-disciplinary provider of children’s services in the Louisville region. Their service lines include Outpatient Behavioral Health, Short- Term Rehabilitation SNF, Dental and General Medical clinics, foster care, and residential housing for children and adolescents. BHS brought Angela to the project to conduct the clinical training and assessment for the medical and SNF departments. She also collaborated and co-presented the operational readiness portions of the project in a series of executive meetings regarding the ICD-10 CM/DSM-5 transition. Among Angela’s responsibilities during this project:
• Perform comprehensive impact assessment and conduct a gap analysis of the current (as-is) state of the provider’s diagnosis coding processes and compare them against standard industry best practices;
• Prepare and present ICD-10 CM clinical training to the HOTI medical staff, consisting of MDs, APRNs, LPN, and Medical Assistants
• Provide best practices in coding and documentation recommendations based on her audits of HOTI’s processes and medical records
• Assess current EHR functioning for ICD-10 readiness and provide recommendations for vendor improvements
• Co-presented and conducted leadership training and meetings regarding assessing current IT systems for ICD-10 readiness. IT systems considered were: Redoc, Practice Administration System, Rehab Optima, PointClickCare, E-MDs, Dentrix, and Kaleidacare
• Advise senior leadership on Compliance and Audit concerns and a high-level assessment of the current HOTI compliance program.
1. Spring-Fall, 2015: Diamond Healthcare Corporation, Richmond, Virginia: Diamond Healthcare Corporation (DHC) is a national leader in contract management and provision of behavioral health management and consulting services. In addition to those services, DHC has a free-standing psychiatric, partial hospitalization, residential, and substance use facility in Williamsburg, VA. DHC provides in-patient psychiatric Program Directors to approximately 66 acute care facilities nationwide. This project involved preparing the national Program Directors for the ICD-10 transition in their facilities and providing project management and clinical training to the Williamsburg campus. Angela was brought into this project for her expertise with acute care facilities and revenue cycle management preparedness for the ICD-10 transition. Specifically, Angela’s responsibilities included:
• Assist BHS in developing a comprehensive ICD-10 transition plan for DHC
• Co-authoring an “ICD-10 Awareness for Program Directors” document that was distributed to the 66 Program Directors in hospitals nationally
• Specifically preparing the clinical training for the ICD-10 transition for the MD and Nursing staff on- staff in Williamsburg
• Conduct an initial assessment and gap analysis and provide recommendations for revenue cycle integrity and enhancement during the ICD-10 transition process
• Review and discuss best practices in charge captures for revenue cycle optimization
• Discuss best practices with the nursing staff and Utilization Review staff
• Perform chart reviews of medical records and provide feedback to the staff in Williamsburg 1. 2014- present, Technical Assistance: As-needed technical assistance and Subject Matter Expert for various other projects, including ICD-10/DSM-5 Transition training for a Federally Qualified Healthcare Center (FQHC) in Manhattan, NY.
Angela has served as an invaluable resource to BHS on various other topics. Her experience and credentials in the medical industry, coupled with BHS’s expertise in the behavioral health industry, has made for a dynamic team for some of BHS’s clients. She has consistently received high praise from BHS’s clients for her delivery style and expertise. Please do not hesitate to contact me should you need further information. Lisette Wright, MA, Licensed Psychologist
Executive Director, Behavioral Health Solutions
*******@***************************.***
612-***-**** mobile
Contact this candidate