Shauna Thayer
Hagerhill,KY
Summary
Dynamic and results-driven professional with extensive experience at Optum, excelling in credentialing compliance and operational efficiency. Proven track record in process improvement and team management, enhancing accuracy and reducing errors.Specialist in strategic planning and skilled in effective communication, ensuring efficient onboarding and strict compliance with State, CMS, and NCQA regulatory guidelines.
Overview
25
25
years of professional experience
Work History
Sr. Credentialing Quality Program Specialist
Optum
01.2025 - Current
- Oversee quality assurance initiatives within the credentialing program
- Analyze data to identify trends and improve credentialing accuracy and compliance
- Provide strategic input on credentialing policies and procedures
- SharePoint site development
Supervisor of Credentialing
Optum
01.2024 - 01.2025
- Supervises credentialing staff, directing daily work, training, performance evaluation, and workflows for multiple states
- Oversee daily credentialing operations
- Investigates discrepancies or issues that arise during the credentialing process
- Developed and implemented process improvements to enhance credentialing efficiency
- Served as liaison between the credentialing department and senior management
Senior Credentialing Representative/ Department Lead
Optum
01.2020 - 01.2024
- The main point of contact for our department, collaborating with other teams and external clinical partners as well as communicating updates up to management
- Prepared and recorded minutes for committee meetings
- Trained team members and managed daily workflow to ensure consistent productivity and quality standards for multiple states
- Managed end-to-end credentialing processes for healthcare providers across multiple regions, ensuring timely and accurate onboarding
- Conducted audits and provided feedback to reduce errors and improve processes and performance
- Executed Primary Source Verifications in alignment with NCQA, CMS, and state-specific credentialing standards
- Processed initial and re-credentialing applications for both individual practitioners and organizational providers
- Maintained accurate provider data and ensured compliance with regulatory standards
Credentialing/Billing Specialist
HopeSparks Non-Profit Family Services
Tacoma, USA
01.2017 - 01.2020
- Initiated credentialing process and maintained provider files for 20+ practitioners
- Managed insurance applications and credentialing profiles - CAQH, Medversant
- Handled billing, denied claims research, and EHR support
Administrative Office Manager
Pace Dermatology Associates
Tacoma, USA
01.2014 - 01.2017
- Oversaw billing operations, ensuring accuracy and timeliness in financial transactions
- Recruited, trained, and managed administrative staff, ensuring efficient team performance and alignment with organizational goals
- Ensured HIPAA compliance across administrative functions through effective oversight and staff education.
- Led staff training initiatives and conducted performance evaluations to support professional development and accountability
- Developed and implemented new policies and procedures to enhance operational efficiency and regulatory compliance
Office Manager
Burki Chiropractic Center
Gig Harbor, USA
01.2009 - 01.2014
- Supervised staff and managed core administrative functions including billing, scheduling, and collections to ensure smooth clinic operations
- Handled internal and external correspondence, contributing to clinic growth and patient engagement
- Organized educational seminars and maintained day-to-day office operations to support strategic initiatives and service delivery
Practice Administrator/Biller
Interventional Pain Management Associates
Vancouver, USA
01.2004 - 01.2009
- Recruited, trained, and managed administrative staff to support operational efficiency and organizational alignment
- Oversaw all human resources functions, including employee relations, onboarding, and compliance
- Managed billing operations and negotiated insurance contracts to ensure timely reimbursement and financial accuracy
- Prepared and submitted quarterly tax filings and reports to the IRS in full compliance with federal regulations
- Coordinated marketing initiatives and hosted networking luncheons with local physician offices to strengthen community relationships and promote clinic services
Referral Coordinator/Insurance Processor
Good Samaritan Surgery Center
Puyallup, USA
01.2001 - 01.2004
- Managed referrals, prior authorizations, and insurance verifications to support timely patient care and reimbursement
- Contributed to policy development and facilitated staff training to ensure operational consistency and compliance
- Scheduled patient appointments and internal meetings, optimizing workflow and resource coordination
Education
BA - Business Administration
University of Phoenix
Online01.2004
Health Unit Coordinator -
Clover Park Technical College
Lakewood, WA01.2001
Diploma -
Bethel High School
Spanaway, WA01.2000
Skills
- Team management
- Recruiting
- Training and development
- Performance evaluations
- Operational efficiency
- Process improvement
- Cross-functional collaboration
- Problem solving
- Effective communication
- Group and individual instruction
- Strategic planning
- Policy creation
- HIPAA compliance officer
- Credentialing processes
- Credentialing compliance
- Enrollment
- Medical billing
- Referrals
- Authorizations
- Insurance verifications
- Community engagement
- Seminar organization
- CAQH
- PECOS
- ICD-9/10
- CPT coding
- Typing speed is 50 to 60 WPM
- 10-key by touch
- Microsoft Office Suite
- QuickBooks
- Excel
- Outlook
- PayNW
- Google Workspace
- Echo
- Kareo
- Centricity
- Castus
- Symplr
- MD-Staff
- NCQA standards
- CMS
- NPPES
Timeline
Sr. Credentialing Quality Program Specialist
Optum
01.2025 - Current
Supervisor of Credentialing
Optum
01.2024 - 01.2025
Senior Credentialing Representative/ Department Lead
Optum
01.2020 - 01.2024
Credentialing/Billing Specialist
HopeSparks Non-Profit Family Services
01.2017 - 01.2020
Administrative Office Manager
Pace Dermatology Associates
01.2014 - 01.2017
Office Manager
Burki Chiropractic Center
01.2009 - 01.2014
Practice Administrator/Biller
Interventional Pain Management Associates
01.2004 - 01.2009
Referral Coordinator/Insurance Processor
Good Samaritan Surgery Center
01.2001 - 01.2004
BA - Business Administration
University of Phoenix
Health Unit Coordinator -
Clover Park Technical College
Diploma -
Bethel High School