Microsoft Offices
Alanna L. Goins
Knoxville,TN
Summary
I desire to seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. I am hardworking and passionate job seeker with strong organizational skills eager to secure new opportunities.
Overview
9
9
years of professional experience
1
1
year of post-secondary education
Work History
AR & Denials Operations Support
R1 RCM Inc.
06.2023 - Current
- Optimized workflows by implementing new software tools designed to streamline the denial review process.
- Served as a subject matter expert on claim denials, providing guidance and support to colleagues across departments.
- Improved communication between departments, expediting the resolution of denied claims.
- Documented information gathered in field and uploaded data to company database for efficient processing using Collect and Quantum.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Collaborated with team members to develop comprehensive log auditing strategies, increasing overall efficiency.
- Maintained accurate records of each trainee's progress throughout programs for future reference and evaluation purposes.
- Worked with over ten different client hospitals and gained access to their internal software in order to gather information needed to send to insurances.
- Obtain shadowing opportunities in Human Resources.
- Joined many workshops or trainings in order to improve my overall stress management and communication skills.
Appeals and Grievances Coordinator
Friday Health Plans
10.2022 - 05.2023
- Assist with the medical department of appeals for member's prior authorizations, or non-covered benefits
- Review appeals via email, standard mail, and fax
- Assign new appeals to other coordinators or myself
- Take phone calls for providers and members to check on status of appeals or answer questions about non-covered medications
- Make important decisions to uphold or overturn an appeal.
- Submitted verbal and written notification to members and providers.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
Pharmacy Technician
Friday Health Plans
05.2021 - 10.2022
- I assist insurance members or providers through the phone or email
- I help research and find the solution to problems
- I speak with our Pharmacy Benefit Manager in regards to placing overrides and knowing statuses of Prior Authorizations
- Let members know whether or not we cover specific medications
- Calculate accumulator issues, quantity limits, and day supplies
- Assist pharmacies to reprocess medications or give insurance processing information
- Help train/assist other members of the pharmacy team with related issues.
Bank Teller
First Southwest Bank
01.2020 - 05.2021
- Able to maintain a good experience for customers
- Helped run transactions; withdrawals, deposits, cashier's check, etc
- Responsible for running diagnostics on ATM as well as balance, add cash, and provide totals for book keeping
- Cleaned and organized stations and teller line.
- Balanced vault and additional money from FED
- Helped open and close accounts for new or existing members
- Trained new hires.
- Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
- Educated customers on use of banking website and mobile apps.
Manager
Metro By T-Mobile
06.2019 - 10.2019
- I supervised 3 employees
- I handled our day-to-day operations
- Assured excellent customer experience
- I recruited new hires
- I kept the store maintained and clean
- I handled the daily count
- Assisted customers with tech problems.
- Accomplished multiple tasks within established timeframes.
- Cross-trained existing employees to maximize team agility and performance.
Customer Service Clerk
Alamosa Quilt Company
06.2015 - 07.2017
- Ensured a great experience to all customers
- Helped customers locate different items that they needed
- Helped with customers transactions.
- Responded to customer needs through competent customer service and prompt problem-solving.
- Educated customers on best-fit selections by listening to personal desires and purchase limitations.
Education
High School Diploma -
Byron Syring Delta Center
Monte Vista, CO 08.2015 - 2019.05
BBA - Human Resource Management
Colorado State University
Global Campus 10.2021 - 06.2022
BBA - Human Resource Management
Southern New Hampshire University
Hooksett, NH 05.2001 -
Skills
Grievance handling
Contract administration
Written Communication
Multitasking Abilities
Teamwork and Collaboration
Planning and Coordination
Data Entry
Deposit and withdrawal management
Spanish speaking
HIPAA Knowledge
Claims Management
Clinical Documentation
Software
Health Edge
Citrix Care Manager
Epic Health Systems
One Content
OnBase
Soverna
Timeline
AR & Denials Operations Support
R1 RCM Inc.
06.2023 - Current
Appeals and Grievances Coordinator
Friday Health Plans
10.2022 - 05.2023
BBA - Human Resource Management
Colorado State University
10.2021 - 06.2022
Pharmacy Technician
Friday Health Plans
05.2021 - 10.2022
Bank Teller
First Southwest Bank
01.2020 - 05.2021
Manager
Metro By T-Mobile
06.2019 - 10.2019
High School Diploma -
Byron Syring Delta Center
08.2015 - 2019.05
Customer Service Clerk
Alamosa Quilt Company
06.2015 - 07.2017
BBA - Human Resource Management
Southern New Hampshire University
05.2001 -
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