Alyssa Jones
Florissant,Missouri
Summary
Operations and compliance professional with over 8 years of experience in high-volume casework within healthcare organizations. Proficient in managing time-sensitive cases while adhering to federal and state regulations. Demonstrated ability to maintain accurate documentation, protect sensitive information, and collaborate effectively across teams. Strong organizational, analytical, and communication skills enable independent workflow management and data tracking, contributing to process improvements in multiple settings.
Overview
5
5
years of professional experience
Work History
Care Coordinator III
Centene
St Louis, Missouri
04.2025 - Current
- Manage a high-volume caseload requiring strict adherence to federal, state, and organizational regulations, while meeting time-sensitive deadlines.
- Serve as a primary point of contact for individuals navigating complex healthcare and benefit processes, providing clear guidance on policies, timelines, and next steps.
- Act as a liaison between multiple internal departments and external vendors, coordinating information flow, and resolving escalations to support accurate case outcomes.
- Independently oversee role-specific workflows as the sole subject-matter resource, ensuring continuity of operations and consistency in case handling.
- Pull, analyze, and maintain operational data in tracking spreadsheets to monitor case volume, trends, and performance for a small functional group.
- Share data insights and status updates with stakeholders to support decision-making and workload planning.
- Maintain accurate, compliant case documentation within enterprise systems, while safeguarding confidential and sensitive information.
- Identify process gaps, and recommend improvements to increase efficiency, reduce rework, and support continuous improvement initiatives.
Prior Authorization Specialist
Centene
Saint Louis, Michigan
11.2024 - 05.2025
- Processed time-sensitive authorization requests while ensuring compliance with federal, state, and payer-specific regulations.
- Communicated interpretations of policy guidelines and eligibility criteria to providers and stakeholders.
- Ensured accurate processing through coordination with external vendors regarding service agreements.
- Submitted detailed appeal documentation to address denials and correct errors.
- Analyzed authorization trends to identify issues and propose workflow enhancements.
Program Coordinator
Centene
St. Louis, MO
03.2023 - 04.2025
- Coordinated program operations to ensure compliance with state and federal requirements.
- Managed eligibility screening and documentation for high-priority cases.
- Tracked and reported program performance metrics to support audits and compliance reviews.
- Analyzed data to drive continuous improvement initiatives and operational decisions.
- Partnered with cross-functional teams to enhance workflows and improve case tracking.
- Ensured accurate record-keeping through effective collaboration with stakeholders.
- Provided critical data analysis to support leadership in policy decision-making.
- Facilitated efficient referrals for high-priority cases, optimizing resource allocation.
Client Engagement Specialist
T care inc
St. Louis, MO
08.2022 - 02.2023
- Managed client cases with accurate documentation, eligibility validation, and consistent follow-up.
- Communicated policies, services, and timelines to diverse populations effectively.
- Resolved service issues by identifying root causes and coordinating corrective actions with internal teams.
- Facilitated client onboarding by guiding users through software features.
- Collaborated with cross-functional teams to enhance customer service strategies.
Clinical Intake Coordinator
life stance health
Johns Creek, Georgia
04.2022 - 07.2022
- Maintained electronic health records, ensuring accuracy and compliance with regulations.
- Communicated with patients to collect medical history and insurance information.
- Collaborated with healthcare providers to optimize referral processes and appointment scheduling.
- Managed intake documentation and transcribed provider notes to assist case managers and adjusters.
- Coordinated provider appointments and precertifications to minimize authorization delays.
- Handled high-volume telephonic intake while ensuring data accuracy and regulatory compliance.
Unemployment Claims Specialist
Missouri Dept. of Revenue
St. Louis, MO
10.2020 - 09.2021
- Administered unemployment claims per federal and state labor regulations.
- Reviewed eligibility criteria and documentation to ensure accurate benefit determinations.
- Served as primary contact for claimants, clearly explaining policies and procedures.
- Resolved appeals and discrepancies, correcting errors to reduce backlog.
- Maintained confidentiality standards while managing sensitive personal data.
- Processed unemployment benefits documentation efficiently.
- Conducted interviews with claimants and employers to collect necessary information.
- Collaborated with departments to ensure compliance with all legal requirements.
Education
Some College (No Degree) - AAS Funeral Service Education
St.louis Community College
St Louis, MOHigh School Diploma -
University City High School
University City, MOSkills
- Case and leave management
- Policy interpretation and compliance
- Labor law adherence
- Confidential records handling
- Employee communication and guidance
- HRIS management (Workday)
- Cross-functional collaboration
- Data analysis and reporting
- Remote work management
- Healthcare policy knowledge
- Claims processing expertise
- Resource allocation strategies
- Quality assurance practices
- Database coordination skills
- Utilization management
Timeline
Care Coordinator III
Centene
04.2025 - Current
Prior Authorization Specialist
Centene
11.2024 - 05.2025
Program Coordinator
Centene
03.2023 - 04.2025
Client Engagement Specialist
T care inc
08.2022 - 02.2023
Clinical Intake Coordinator
life stance health
04.2022 - 07.2022
Unemployment Claims Specialist
Missouri Dept. of Revenue
10.2020 - 09.2021
Some College (No Degree) - AAS Funeral Service Education
St.louis Community College
High School Diploma -
University City High School