LaShonda's Resume
La’Shonda N. Gordon
3211 O’Neal Ln
Baton Rouge, LA 70816
------------
------------
QUALIFICATIONS SUMMARY
Mastered Excellent Written and Verbal Communication proficiency within the Healthcare Industry. Conflict Management and Counseling expertise attributed to ability to resolving wide array of diverse and complex situations while ensuring compliance. Committed to Excellence through providing quality customer service equating to repeat business and above average customer feedback
EDUCATION
Woodlawn High – High Diploma August 1998 - May 2002
Newspaper Columnist (poetry), Active in school choir
University of Phoenix – A.A. Mass Communications June 2008 - March 2011
PROFESSIONAL EXPERIENCE
University of New Orleans July 2018-Present
Louisiana Department of Health
Chisholm Compliance Coordinator
• Assist the Chisholm Compliance Officer in monitoring 3 MCOs for compliance with all Chisholm and ABA Orders and Stipulations
• Daily look for new PA’s for Extended Home Health, ABA and EPSTD Personal Care Services
• Analyze each PA to ensure that the notice meets all Chisholm requirements
• Contact recipients to ensure they are receiving services
• Worked on several reports
Ameri-Health Caritas, Louisiana Dec 2015- June 2018
Provider Network Analyst Operations
• Updating provider profiles and updating agreement id’s for providers
• Collecting and processing credentialing information for providers
• Work on provider claims issues
• Utilized time management to ensure that Provider Roster Validations and attestations completed
• Receiving and sorting mail
Frazee Recruiting April 2014 - December 2014
Intake Coordinator with Blue Cross Blue Shield of Louisiana
• Answered calls to set up pre-authorizations
• Created profiles to ensure patient insurance information is valid and up to date
• Settled customer disputes
• Utilized diagnostic and procedure codes
Med Solutions, Melbourne, FL September 2011 - November 2013
Intake Coordinator
• Answered calls to set up pre-authorizations
• Assisted several health plans with member appeals
• Assisted members making appointments for services
BlueCross BlueShield Baton Rouge, LA May 2010 - August 2011
ITS Provider Advisor
• Answered general questions from healthcare providers regarding out of state insurance claims
• Utilized ITS adjustments to adjust any claims that paid incorrectly
• Worked on daily log to correct any additional issues with claims that were not processed
• Contacted healthcare providers to mitigate incorrectly submitted or missing information
Blue Cross Blue Shield Baton Rouge, LA.
Imaging Clerk November 2007 - May 2010
• Sorted, batched and scanned claims and member enrollment forms
• Reviewed microfilm
• Maintained logs of daily activities and tasks
• Accessed archived images and files
TECHNICAL SKILLS
• Appian
• BPO
• Facets
• Knowledgeable of ICD-9, ICD-10 and CPT
• IBM Host –Extra
• Jiva Systems
• Microsoft Office (Word, Excel, PowerPoint and Abstraction)
• Medical Terminology
• Outlook Email
• SharePoint
• Streamline
• Data Triage
• Type 60 wpm
• Visual Cactus
• Claims Processing
• LMMIS
La’Shonda N. Gordon
3211 O’Neal Ln
Baton Rouge, LA 70816
------------
------------
QUALIFICATIONS SUMMARY
Mastered Excellent Written and Verbal Communication proficiency within the Healthcare Industry. Conflict Management and Counseling expertise attributed to ability to resolving wide array of diverse and complex situations while ensuring compliance. Committed to Excellence through providing quality customer service equating to repeat business and above average customer feedback
EDUCATION
Woodlawn High – High Diploma August 1998 - May 2002
Newspaper Columnist (poetry), Active in school choir
University of Phoenix – A.A. Mass Communications June 2008 - March 2011
PROFESSIONAL EXPERIENCE
University of New Orleans July 2018-Present
Louisiana Department of Health
Chisholm Compliance Coordinator
• Assist the Chisholm Compliance Officer in monitoring 3 MCOs for compliance with all Chisholm and ABA Orders and Stipulations
• Daily look for new PA’s for Extended Home Health, ABA and EPSTD Personal Care Services
• Analyze each PA to ensure that the notice meets all Chisholm requirements
• Contact recipients to ensure they are receiving services
• Worked on several reports
Ameri-Health Caritas, Louisiana Dec 2015- June 2018
Provider Network Analyst Operations
• Updating provider profiles and updating agreement id’s for providers
• Collecting and processing credentialing information for providers
• Work on provider claims issues
• Utilized time management to ensure that Provider Roster Validations and attestations completed
• Receiving and sorting mail
Frazee Recruiting April 2014 - December 2014
Intake Coordinator with Blue Cross Blue Shield of Louisiana
• Answered calls to set up pre-authorizations
• Created profiles to ensure patient insurance information is valid and up to date
• Settled customer disputes
• Utilized diagnostic and procedure codes
Med Solutions, Melbourne, FL September 2011 - November 2013
Intake Coordinator
• Answered calls to set up pre-authorizations
• Assisted several health plans with member appeals
• Assisted members making appointments for services
BlueCross BlueShield Baton Rouge, LA May 2010 - August 2011
ITS Provider Advisor
• Answered general questions from healthcare providers regarding out of state insurance claims
• Utilized ITS adjustments to adjust any claims that paid incorrectly
• Worked on daily log to correct any additional issues with claims that were not processed
• Contacted healthcare providers to mitigate incorrectly submitted or missing information
Blue Cross Blue Shield Baton Rouge, LA.
Imaging Clerk November 2007 - May 2010
• Sorted, batched and scanned claims and member enrollment forms
• Reviewed microfilm
• Maintained logs of daily activities and tasks
• Accessed archived images and files
TECHNICAL SKILLS
• Appian
• BPO
• Facets
• Knowledgeable of ICD-9, ICD-10 and CPT
• IBM Host –Extra
• Jiva Systems
• Microsoft Office (Word, Excel, PowerPoint and Abstraction)
• Medical Terminology
• Outlook Email
• SharePoint
• Streamline
• Data Triage
• Type 60 wpm
• Visual Cactus
• Claims Processing
• LMMIS