Business Analyst Project Manager

Linda Pigue, MHA, CBCS

*** ******** ******, *** ****, IL 60302

Main: 312-***-****

Contact Methods: Call Text WhatsApp

E-mail: **********@****.***

High-level Principal Experience

Effectively engaged in several short and long term complex projects and implementation projects on-site and remote

Developed workflows and conducted gap analysis to identify revenue opportunities across departments

Billing and coding best practices, contract administration, analyze optimal performance in staff, technology and processes

Applications and Methodology

Areas of Expertise

Epic EMR, ADT, Cadence, Prelude and ClinDoc

Cerner Millennium EMR

GE Centricity EMR and IDX

Avisena EMR

Athena EMR

Medical Manager EMR

MEDITECH

MMIS and Medi-systems

Availity, NaviNet and Change Healthcare

SharePoint, Connex, and Medi-System

Microsoft Applications/ MS Project/Access/Outlook

Visio

Scrum (Book Knowledge) and Agile Methodology/ Risk Management/ Project Management

Account Receivable Management Life cycle

Contract Administration / Charge Master Management

Denial Management / Collections /Credentialing

Training / Mentor /Team Building

Process Improvement /Gap Analysis /Appeal Writing

Financial Reporting Tools and Analysis Report

Clinical and Financial System Implementation

ICD-10 Assessment/ Remediation/ Implementation

Coding: ICD-9 and ICD-10, Modifiers, HCPCS and CDI

Test Script /Scenarios/ Build Workques/SQL

Financial Forecasting / Accounting /GAAP

Payer Domain (Commercial, Government, HMO, PPO WC), claim adjudication life cycle

835 ERA and 837; EDI claims; and Clearinghouse

PPO, HMO and Managed Care products

System Conversion and Integration and CRM experience

Contracted Projects and Permanent Assignments (Remote / Traveling / Onsite)

Children and Family Comprehensive Health Outreach, Inc. (501C3 Non-profit organization) 04/2018 to 04/2023

Remote Project Manager/Senior Business Analyst and Revenue Cycle Consultant

Project Manager of community development in Ghana, Africa; worked closely with Leaderships, vendors and communities

Business planning and development, overseen compliance and regulations, accounting, tax preparation and budgeting

Researched, identified RFPs and Grants for business needs, identified key stakeholders’ skills-sets to meet qualifications for submission, ensured compliance are properly met, provided updates on progress and overseen project until completion

Managed medical billing services, credentialing, contract management, writing appeals, and volunteered teaching medical billing, revenue coding to aspiring learners and Human Resources Coordination conducted payroll, recruiting, training and assessments

Worked with Athena EHR offshore team to streamline processes, performed extensive denial management and input charge entry

Enhanced workflows, performed medical coding for physician and hospital settings, CDI, credentialing, charge master

DrChrono and Athena EHR; completed enrollment processes with Clearinghouse/Trizetto and contracted payers and fee-sheet analyses

Educated front-end to enhance efficiencies in workflow and industry compliances; MACRA and MIPS compliance submission

Produced weekly status report to principals outlined deliverables, road-blocks, recommendations and next steps

Ensured practice maximize revenue opportunities; and analyzed contract administration with software vendors and payers

Coordinated with clinical team to ensure clinical performance measurements were satisfied, documented and submitted to payers

Trained Interns medical billing and coding; Medicaid, Medicare, Commercial, Managed Care claims adjudication maximizing revenue

Physician Revenue Group (Mid-size Billing Service) Downers Grove, Illinois 08/2017 to 02/2018

Contracted Revenue Cycle Management Consultant (Project)

Audited financial reports to uncover discrepancies in billing, coding, work flows and assist the Vice President with multiple tasks

Engaged in new client start-ups transition implementation with systems, billing, coding and credentialing

Worked closely with sales team to understand client nuances and complexities; and engage in presentations

Collaborated with off-shore teams to ensure effective Athena EHR, GE Centricity IDX workflow and financial reporting

Point of contact for Cardiology, OB/GYN, CRNA, Pain Management, Internal Medicine, Pediatricians and Oncology groups

Resolved the highest level of revenue-cycle management escalations with coding; and insurance denials and recoupment

The Georgia Doty HIV and Hepatitis Community Outreach, Inc. (Non-profit Organization) Chicago, Illinois 06/2004 to 08/2017

Project Manager/Coordinator/ Accountant

Reviewed grants to discover metrics and meet with key-stakeholders and resources to address needs

Wrote grants from federal, state and private sources to request funding to support organizational /community needs

Ensured compliance and requirements are met on a state and federal level

Created a statewide budget for events, balance operational budget, account payables, and financial reporting to Board Members

Seattle Children’s Hospital (Hospital) Seattle, Washington 09/2015 to 02/2016

Senior Business System Analyst (Project)

Identified system deficiencies for enhancement and produce solutions

Supported Super users in Troubleshooting coding issues, conducted testing within Epic Clinical application, 3M and Optum

Created testing workques in Epic contingent on business user needs to facilitate and for coding

Reported issues on 3M and Optum CRM, created test scenarios and end-user errors for solutions and SQL inquires

BlueCross BlueShield (Insurance Company) Chicago, Illinois 07/2015 to 09/2015

Contracted Senior Business Analyst-Co-lead Clearinghouse ICD-10 Project

Reviewed data on incoming 837 setup form to ensure 835 ERA form was effectively completed for ICD-10 testing

Analyzed data to ensure providers submitted 835 ERAs setup forms accurately

Communicated with medical providers and clearinghouses regarding a corrected data for ICD-10 testing

Delivered results by ensuring PLT numbers were submitted correctly for ICD-10 testing

Informed clearinghouses of file names and claims to send to providers via test 835 ERA

QuadMed, Inc. (105 Clinics-Large Ancillary Employer Sponsor) Sussex, Wisconsin 04/2015 to 07/2015

Contracted ICD-10 Implementation and Revenue Cycle Management Business Analyst (Project)

Performed an effective ICD-10 Assessment consist of 105 clinics throughout United States

Identified Coding and Clinical Documentation impacts within three major business models as it relates to revenue

Successfully conducted interviews with upper-management and front-line staff to assess roles, responsibilities and processes

Created an effective ICD-10 Implementation plan less than six weeks for the entire enterprise

Formulated an ICD-10 Educational Plan to demonstrate the importance of implementing ICD-10

Designed several presentations highlighting impacts in people, processes, technology; policies and procedures, and compliances

Met with decision-makers to discuss progress, impacts and solutions to move company forward in implementing ICD-10

McKesson, Inc. (Business Performance Solutions/ Consulting) Chicago, Illinois 10/2014 to 04/2015

Revenue Cycle Client Manager

Spearheaded engagement with 25 physicians’ groups and physicians’ leadership team at Cook County Hospital

Utilized McKesson’s reporting tools to assess clinical and financial productivity amongst various physician groups

Assisted in preparation of client deliverables including data analyses, quality review, and presentations

Fostered and maintained successful client relationships generating positive client feedback on quality, value, and results

Established performance expectations amongst billing operations and coding teams with Cerner Millennium application

Effectively coach and motivated clients and direct team in innovative ideals

Demonstrated high level of self-awareness of client’s needs and producing transparent solutions

Primary Medical Healthcare Practice (Medical Practice) Marietta, Georgia 05/2014 to 09/2014

Contracted Remote Senior Business Healthcare Advisor (Project)

Clinical coding for homotoxicology, medical nutrition and medical services, and performed credentialing

Assisted in vendor Electronic Health Records and Practice Management selection

Implemented process improvement with patient access and registration department to maximize revenue

Pivot Point Consulting (Lane Regional Medical Center) Baton Rouge, Louisiana 01/2014 to 03/2014

Contracted Traveling ICD-10 Senior Business Analyst (Project)

Created Project Workbook to assist the IT and Education teams to gather documents for MS Project Plan

Engaged as an ICD-10 Subject Matter Expert in IT, Revenue Cycle, HIM, Education and Clinical implementation activities

Produced weekly status reports for the Program Director and assisted as CPOE new code-set development advisory

Implemented methodology, via questionnaires to measures processes for IT, PFS, Physician Practice, and SNF impacts

Assisted with the development of work plans for Revenue Cycle, HIM, IT, Coding, and Education teams

Accountable for assuring objectives were met, Provided leadership to multi-disciplinary teams

Effectively communicated relevant project information to leadership on a weekly basis

Monitored MS Project Plan and prepared reports to ensure work is progressing to meet the deliverables, timely

Solved conflicts and issues in a timely manner as it relates to the project plan

Assisted in managing day-to-day operational aspects of a project and scope

Vaco Health Care (Regional Care Hospital- Eight Systems) Tennessee, Connecticut, Alabama, Pennsylvania 09/2013 to 12/2013

Contracted Traveling ICD-10 Senior Business Analyst (Project)

Performed an ICD-10 Revenue Cycle, Management HIM, CDI and IT assessment for Regional Care Partners enterprise

Interviewed senior management to assess potential impacts within their operations by creating questionnaires

Produced weekly status reports and preliminary reports to the Program Director

Collected Business Requirement Documents to assess revision needs for ICD-10 implementation

Prepared for ICD-10 implementation via MS Project Plan by compiling Action, Issue and Risk

Effectively communicated project status information to leadership

Longwood Cardiology Medical Group (Urgent Care and Ambulatory Practice) Longwood, Florida 06/2013 to 09/2013

Contracted Revenue Cycle Consultant and Interim Administrator (Project)

Mapped impacts in procedures as it relates to technology, processes and staff productivity (patient access, registration and billing)

Conducted weekly meetings to engage staff in change management and allocation of tasks

Mapped claims submission issues with Athena application to increase revenue and enhance processes

Ensured 835 claims reflects insurance contractual payments and adjustments

Discussed progress, recommendations and solutions with principals

Resolved staffing conflicts, claims processing, litigation, appeals and customer service concerns with 7 direct reports

Created financial spreadsheets to combat denials trends, application and staffing issues

Educated staff the importance of ICD-10 transition as it relates to clinical documentation and coding

Prepared SNOMED ICD-10 mapping on Athena practice management application

Vitalize Consulting Solutions (John Muir Hospital) Orlando, Florida 07/2012 to 03/2013

ICD-10 Business Analyst (Project)

Created an ICD-10 Code Mapping Methodology approach relating to clinical and revenue impacts

Created PowerPoint identifying EMR Order Sets Impacts and Physician ICD-10 Impact Analysis

Proposed a business plan within the Regional Extension Centers program

Assisted peers in resolving project complexity with relations to clinical processes

Created a comprehensive ICD-10 educational plan for targeted audience throughout the enterprise, per Project Director request

Mapped all functional areas to assess for people, process and technology with potential impacts with ICD-10 new code-sets

Analyzed historical data via SharePoint to assess validity; produced an analysis report for the Project Director

Assisted HIM Director with vendor’s RFP selection for staffing needs relating to ICD-10 transformation

Orchestrated potential interviews with key-stakeholders to discuss internal ICD-10 operational impacts

Developed questionnaires contingent on EPIC workflows to perform a gap analysis within targeted areas

Produced a weekly status report for the Project Director

HCL Technologies/Saxon Global (Orlando Health Hospital) Orlando, Florida 01/2012 to 03/2012

Contracted ICD-10 Senior Business Analyst /Assessment/Remediation Specialist (Project)

Produced weekly status reports and deliverables for senior-level management via Microsoft applications

Conducted assessment and remediation analysis for Coding and HIM departments to identify impacted areas with people, process,

technology, standard operating procedures and clinical documentation within the hospital and physician environment via

interviewing project key-stakeholders and obtaining business document requirements; created workflows, via Visio, completed

validation process and performed gap analysis

Collaborated with an offshore team to finalize workflow plans’ objectives and goals were accomplished

Utilized a Prizm methodology approach to identify level of impacts within the targeted areas

Assisted with the development of a preliminary report for future remediation approach in project proposal

CSI Companies (Florida Hospital) Orlando, Florida 04/2011 to 11/2011

Contracted System Analyst/Trainer (Project)

Gained knowledge of developing electronic clinical order sets assessments care plans via Cerner PowerNote

Assisted clinicians with attaining Meaningful Use requirements via Ad Hoc Charting, created testing plans via scenarios

Performed gap analysis by creating clinical and financial workflow and business requirements documents

Proactively identify opportunities by implementing change management with front-end and back-end operations

UCF Pegasus Health (Academic Institution and Ambulatory Practice) Orlando, Florida 01/2011 to 03/2011

Contracted Healthcare Resource Consultant (Project)

Assisted IT department with planning Cerner’s Millennium billing module with Pegasus Health and insurance carriers to make certain claims were accurately processed electronically

Researched molecular and cytopathology clinical codes (ICD-9, CPT-4, Modifiers, and HCPCS), and captured Medicare, Workers Compensation, and Commercial insurance fees scheduled for innovative laboratory center

ARMI Consulting (Consulting Company) Illinois, Georgia, and Florida 01/2004 to 12/2010

Director of Finance Operations and Project Manager

Trained and coordinated 15 Independent Consultants’ roles, responsibilities and objectives; produced timelines and

deliverables, forecast budgets, created tracking methods to report level of impacts in financial and clinical operations

Assessed and streamlined clinical, financial processes by conducting a gap analysis and GAAP experience

Collaborated with key-stakeholders to implement change management necessary to achieve optimal results

Developed policies and procedures to ensure compliance; created RFPs for contracting opportunities

Performed life cycle of revenue management, RAC Audits, performed Clearinghouse audits, outstanding collections

on bad debt accounts, extensive follow-up task and filed appeals resulting in increase in revenue; and contract administration,

mentor, trained, and motivated the team to drive for excellence

Performed Human Resources responsibilities, training personnel, sales and marketing project

Trained Super users with Avensia EMR, Athena, Cerner, and GE Centricity IDX

Engage in software implementation and testing to ensure IT requirement needs were met, modification and monitoring data

Education and Professional Development

Master’s degree in Health Care Administration-graduated with honors-University of Phoenix, Orlando, Florida

Bachelor’s degree of Organizational Management- graduated with honors- Concordia University, River Forest, Illinois

Licensed Substitute Teacher with Illinois State Board of Education

Certified Billing and Coding Specialist (CBCS)- National Health-Career Association

ICD-10 Corporate Boot Camp Training- Vitalize Consulting Solutions

Professional PMI Certificate, Agile Methodology/Risk Management- SAIC University e-Learning Management

Certificates in Evaluation and Management Score Sheet 101 Basics, Comprehensive Error Rate Testing; Evaluation

and Management Modifiers- Novitas Solutions

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