Manager Registered Nurse

Keith C. Hawman *** Eckhart Drive Joppa, MD ***** Home: 443-***-**** ******@*******.***

Manager, Healthcare Policy Specialist and former Director, Subject Matter Expert and Educator with experience in civilian and military healthcare systems, medical association’s, insurance companies, as well as with government contractors. Clinical and Management experience includes managing full-time, part-time, civilian, military, volunteer, exempt, and non-exempt personnel. Current role as a Manager of Public Policy with a medical association. Former Certified Professional Coder (CPC) and was certified in Healthcare Compliance (CHC). Veteran: U.S. Navy (Hospital Corpsman)

Achievements include:

Successful Leader who was assigned to lead several workgroups, including: Telehealth Services, Evaluation and Management (E/M) Documentation and Coding change, and staff representative for American Medical Association (AMA) Specialty Society RVS Update Committee (RUC), and CPT Editorial Panels

MedStar Corporate Compliance Education Director: The department was awarded the National Health Ethics Trust (HET) “Best Practices Education” award in 2009 for the successful MedStar annual compliance seminar, held in January 2009

Medicare and the Affordable Care Act (ACA) Subject Matter Expert (SME): 15 years of experience including Medicare Integrity Program (MIP), Policy, and Provider Outreach and Education

President of the American Academy of Professional Coders (AAPC) Central Maryland Coding Chapter – Calendar Year 2006

Professional Experience:

Public Policy Manager

American Urological Association (AUA) November 2018 to Feb. 2021

Linthicum, MD

Analyzes and drafts the AUA response to rulemaking such as the Medicare Physician Fee Schedule, the Hospital Outpatient and Ambulatory Surgical Centers and Hospital Inpatient payment systems. This includes the drafting of accompanying fact sheets, talking points, and informational articles.

Advocates for key positions before the Centers for Medicare & Medicaid Services, Food and Drug Administration, and other federal agencies.

Cultivates issue-based and strategic stakeholder groups/coalitions to support AUA comment letters and position statements.

Actively participate in the development of the biannual policy priorities survey and analysis of results.

Manages strategic review of insurer activities, including communications with the major national insurance companies. Actively engages the National Insurer Advisory Workgroup and salient committee chairs in strategic discussions.

Supervises the Policy Analyst and co-supervises the Policy and Advocacy Specialist with the Senior Manager, Patient and Research Advocacy.

Works directly with physicians and other medical societies regarding the AMA RUC and CPT process. This includes conducting the code survey and completing the necessary forms, as well as attending the various AMA meetings.

Drafts reports for Board of Directors meetings. Submits weekly updates and monthly operational reports.

Oversees the development of committee and workgroup agendas to assure productive meetings and discussions on timely topics and activities that result in proactive recommendations for consideration by the Board of Directors.

Assists the Director with the development and monitoring of reasonable budgets, financial transactions, and reporting for assigned area in accordance with AUA policies and standard operating procedures.

Subject Matter Expert/HealthCare Policy Specialist; Senior Quality Analyst

Marketplace (Affordable Care Act/ACA); Medicare Part B; Five Year Contract

HighPoint Global June 2013 to June 2018 Baltimore, MD

Duties include, but not limited to:

Research, review, revise, and validate training and content materials and documentation to ensure compliance with the Affordable Care Act (ACA) and Medicare policies, procedures and related call center operation’s (CCO) procedures and technologies.

Answer questions from the Client (CMS) as the Subject Matter Expert for various training materials that are developed for Customer Service Representatives (CSR’s).

Facilitate internal meetings as the Subject Matter Expert for the Next Generation Desktop (NGD) system which is used by the CSR’s. Maintain spreadsheets in the SharePoint system that includes all tickets regarding enhancements and corrections to the NGD system.

Maintain knowledge and subject matter expertise through continuous review of the ACA and Medicare policies, procedures, publications, training materials, etc.

Review and update CCO training materials, scripts, and other related information based upon expert knowledge of the ACA and Medicare.

Attend regular meetings with the Client (CMS) management team and staff. Provide updates regarding NGD improvements for training purposes.

Review and analyze information obtained from multiple governmental, legislative, and regulatory sources for impact on Content and Training products.

Compose policy summaries; set priority level of policy update; identify the impact or potential impacts; and post such analysis to Policy SharePoint system.

Travel to partner locations and participate in call listening exercises, focus groups and classroom training observations.

Meet with and share analysis with other TQC Team members.

Flexibility to occasionally work extended hours for testing and product deployments.

Senior Manager, Medicare Research and Policy – Program Integrity Division

XL Health/UnitedHealth Care May 2012 to January 2013 Baltimore, MD

Duties include, but not limited to:

Created and maintained a strategic plan that outlines the goals and major projects for the Medicare Research and Policy department. Direct reports include four professional personnel, one of whom is a certified professional coder and certified fraud examiner.

Manage the daily review of various websites (including the RAC, PSC and MAC), as well as the CMS Manuals to ensure that new and existing provider recovery categories are developed and reviewed to ensure compliance and successful financial recoveries.

Medicaid and Medicare Program Integrity Program Manager

HealthCare Resolution Services (HCRS) November 2011 to March 2012 Laurel, MD

Duties include, but not limited to:

Manage Medicaid and Medicare Program Integrity (PI) service lines. Direct reports include twenty professional personnel, including an auditing manager, who perform both complex medical review and coding audits. Professional staff includes the following: Registered Nurse’s (RN), Certified Professional Coder’s (CPC) Dental Coder’s, and Pharmacy Technician’s.

Managing fraud, waste and abuse (FWA) desk and field audits for the Medicaid contract in 19 states.

Director of Clinical Compliance; Director of Compliance Education and Communications

MedStar Health, Corporate Office September 2008 to November 2011 Columbia, MD

Duties include, but not limited to:

Direct the system-wide operational activities of the Corporate Compliance Program relating to compliance with federal and state laws, regulations, and processes for accurate facility and professional coding and billing, and other compliance related activities.

Oversee the monitoring, auditing, training and education efforts regarding the accuracy and completeness of medical documentation, coding, billing and compliance, in accordance with corporate policies and Medicare standards.

Manage four professional personnel, including an auditing manager, who perform documentation and coding audits and compliance reviews, and develop coding and compliance education materials.

Education: BS, Business Management, University of Phoenix. Note: I attended the on-ground campus in Timonium, MD. Graduation: August 2005. GPA: 3.49

Past certifications include:

Certified HealthCare Compliance (CHC) through the HCCA, and Certified Professional Coder (CPC) through the AAPC. US Navy Veteran. Former Hospital Corpsman and certified EMT and Paramedic.

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