JANAYA ANDERSON
Smyrna,TN
Summary
Detail oriented professional with the proven ability to manage time, communicate with others effectively and take on multitasking. Capable of leading, encouraging, and guiding staff on new processes as well as being able to form strong relationships with my peers, with experience and proven knowledge of customer communications, records management, and service delivery. Aiming to leverage my skills to assist with developing my peers and identifying areas of opportunity.
Overview
13
13
years of professional experience
Work History
Appeals and Grievances Coordinator
Elevance Health
Brentwood, TN
10.2022 - Current
- Processed and finalized 15-20 appeals and grievances within agreed-upon turnaround time.
- Submitted verbal and written notification to members and providers.
- Provided outreach for additional information for appeals and grievances.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
- Entered appeal requests in appeals module.
- Worked flexible hours; night, weekend, and holiday shifts.
- Review records for appeals team,validating appeal criteria is met
POST DECISION SUPPORT SPECIALIST
MyNexus/Elevance Health
03.2020 - 10.2022
- Completed over 150 denial letters for services denied by medical director
- Generates and prints denial letters for mailing
- Provides feedback to ensure denials are handled according to CMS guidelines
- Collaborates with other departments to produce letters for denied services
- Handles returned mail
- Fax Urgent documentation in timely manner
SERVICE DELIVERY SPECIALIST
Mynexus/Elevance Health
03.2018 - 03.2020
- Answers and routes incoming calls from providers , medical groups and others verifying referral status
- Provided basic service desk help with portal issues
- Created new auths, uploaded documents to patient records
- Data entry with oasis
- Complies with HIPAA standards
- Analyzed load-related documentation and completed and accurate records.
QUALITY CONTROL SPECIALIST
Smile Direct Club
06.2017 - 02.2019
- Met or exceeded service and quality standards every review period
- Gathered and verified all required customer information for tracking purposes
- Routinely collaborated with department managers and correct problems and improves services
- Identified process improvements in the day to day functioning of the department
PICKER, Universal Logistics Holdings Inc
01.2017 - 08.2017
- Stacked and stored pallets at the end of the shift to keep warehouse clean and organized
- Reported all equipment failures and malfunctions to supervisor
- Taught the new hires the process
- Moved stock and other materials to and from storage and production areas and loading docks
- Cleaned and maintained the warehouse in compliance with OSHA safety standards
COMPUTER SPECIALIST
Quanta
12.2015 - 01.2017
- Provided continued maintenance and development of bu g fixes and patch sets for existing web applications
- Established compatibility with third party software products by developing program for modification and integration
- Diagnosed and troubleshoot UNIX and Windows processing
- Problems and applied solutions to increase company efficiency
- Provided documentation on start-up, shut down and first level troubleshooting of processes to the help desk
PICKER/PACKER, Amazon
01.2011 - 10.2015
- Trained staff on material handling processes to reduce shipping times
- Stocked, staged and transported goods
- Redirected shipments en route in response to customer requests
- Loaded and unloaded pieces into boxes for shipment
- Led warehouse improvement initiatives to advance operational efficiencies
Education
Associate of Applied Science - Science
NATIONAL COLLEGE oF BUSINESS
Nashville, TN2009
Bachelor of Science - Business Administration And Management
WESTERN GOVERNORS UNIVERSITY
Utah2024
Skills
- Microsoft Office
- Excellent written and oral communication
- Detail and task oriented
- Appeals Support
- Customer Satisfaction
- Service Delivery
- Productivity Standards
- Administrative Support
Timeline
Appeals and Grievances Coordinator
Elevance Health
10.2022 - Current
POST DECISION SUPPORT SPECIALIST
MyNexus/Elevance Health
03.2020 - 10.2022
SERVICE DELIVERY SPECIALIST
Mynexus/Elevance Health
03.2018 - 03.2020
QUALITY CONTROL SPECIALIST
Smile Direct Club
06.2017 - 02.2019
PICKER, Universal Logistics Holdings Inc
01.2017 - 08.2017
COMPUTER SPECIALIST
Quanta
12.2015 - 01.2017
PICKER/PACKER, Amazon
01.2011 - 10.2015
Associate of Applied Science - Science
NATIONAL COLLEGE oF BUSINESS
Bachelor of Science - Business Administration And Management
WESTERN GOVERNORS UNIVERSITY