Summary
Overview
Work History
Education
Skills
Timeline
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LaShonda Thomas-Butler

Belleville,IL

Summary

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.Works productively with facilities, provider groups and individual professionals.

Overview

9
9
years of professional experience

Work History

SENIOR PROVIDER CREDENTIALING REPRESENTATIVE

Optum Healthcare
06.2022 - Current
  • Receive and review credentialing application and other supporting documents to determine if required and necessary information is included.
  • Verify and validate provider credentials, licenses, certifications, and other required documents.
  • Contact and follow-up as needed with provider and request assistance from Provider Group or Network Contracting team to obtain missing information.
  • Educate internal and external stakeholders regarding application process regarding DEA, CDS and education guidelines.
  • Submit, enter and update provider information from application, prime source verification, and/or clients into applicable databases.
  • Communicate with providers via e-mail, phone or other methods pertaining to credentialing status.
  • Perform audit of provider file in order to ensure documentation meets state, federal, and industry standard.
  • Maintain accurate and up-to-date credentialing databases and systems.
  • Supports special assignments and projects as assigned.
  • Drafted agendas, recorded minutes and generated documents to facilitate meetings.
  • Manages own duties and functions independently.



FOSTER/ADOPT INTAKE COORDINATOR

United Healthcare
01.2022 - 06.2022
  • Manage administrative intake of members
  • Assign cases to Care management team
  • Facilitated communication between the referring agency, family members and other stakeholders involved in the process of providing care for clients
  • Completed detailed intake paperwork including assessment forms, clinical notes and other required documents in a timely manner
  • Conducted initial assessments of clients' needs by interviewing them to determine eligibility for services offered
  • Scheduled and coordinated patient intake appointments, verifying insurance coverage and obtaining necessary authorizations
  • Provided education about available programs, services as well as relevant policies, procedures
  • Maintained accurate records of patient information to ensure confidentiality according to HIPAA guidelines.

HEALTH COACH

United Healthcare
01.2020 - 01.2022
  • Evaluate appropriateness of wellness program for member according to exclusionary criteria
  • Perform clinical assessments of members as well as provide health education, transportation, housing, food insecurity, financial stress and housing
  • Coach members on the phone or digitally, leveraging motivational interviewing techniques to help member identify and understand their intrinsic goals and motivate members to engage in positive behavior changes
  • Deliver effective telephonic/chat coaching in a manner that promotes behavior change
  • Locate additional available resources based on member needs and trigger as necessary
  • Document assessment information and health plans in relevant computer systems according to standard protocols and quality.

CLINICAL ADMINISTRATIVE COORDINATOR/BUSINESS SEGMENT LIAISON

United Healthcare
04.2017 - 01.2020
  • Serve as the Missouri Community and State Managed Care Health Plan primary point of contact regarding medical/behavioral and/clinical services eligibility
  • Receive referrals and enroll members in the appropriate program
  • Support Care Coordination team by telephoning providers to verify member's regularly visits and verify member's demographic information
  • Create and Edit spreadsheet with member's program enrollment and demographics
  • Manage monthly Elevated Blood Level/ Substance Abuse and ER Diversion Reports
  • Make daily Provider calls to assure member visits are completed
  • Experience with ICUE, FACETS, Community Care and Cyberspaces
  • Serves as the Business Segment Liaison for the Health Plan
  • Responsible for the Onboarding of new employees
  • Submit requests through Service Now and Secure
  • Complete all assigned Administrative duties.

PATIENT ADVOCATE/ FIELD REPRESENTATIVE

Cardon Outreach at St. Elizabeth's Hospital
09.2014 - 03.2017
  • Interview and screen patients inpatient, outpatient or by telephone for Medicaid eligibility
  • Initiate and complete the application process for benefits by assisting applicants with the completion of necessary paperwork
  • Perform home visits, field visits and any necessary items to expedite cases
  • Protect the privacy of all PHI in accordance to privacy policies and procedures and as required by state and federal law
  • Work with county Medicaid eligibility workers and county offices to create a positive working relationship
  • Billing commercial insurance, Medicaid and Medicare using EHR Meditech and Revenue Cycle Management.

Education

Bachelor's - MULTIDISCIPLINARY STUDIES

Illinois State University
Normal
08.2004

Associate - SOCIOLOGY

Heartland Community College
Normal, IL
01.2001

Skills

  • Deadline-oriented
  • Documentation and reporting
  • Organization skills
  • Sufficient in Microsoft
  • Managed Care
  • Customer Service
  • Administrative support
  • HIPAA compliance
  • Data Entry Proficiency
  • Effective Communication

Timeline

SENIOR PROVIDER CREDENTIALING REPRESENTATIVE

Optum Healthcare
06.2022 - Current

FOSTER/ADOPT INTAKE COORDINATOR

United Healthcare
01.2022 - 06.2022

HEALTH COACH

United Healthcare
01.2020 - 01.2022

CLINICAL ADMINISTRATIVE COORDINATOR/BUSINESS SEGMENT LIAISON

United Healthcare
04.2017 - 01.2020

PATIENT ADVOCATE/ FIELD REPRESENTATIVE

Cardon Outreach at St. Elizabeth's Hospital
09.2014 - 03.2017

Bachelor's - MULTIDISCIPLINARY STUDIES

Illinois State University

Associate - SOCIOLOGY

Heartland Community College

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LaShonda Thomas-Butler