Tineka Goldsby
Cypress
Summary
Operations manager with strong expertise in risk management and healthcare compliance. Demonstrated success in implementing process improvements that significantly enhance operational efficiency. Skilled in delivering actionable insights that drive organizational performance.
Overview
9
9
years of professional experience
Work History
Manager, Risk Adjustment Operations
Centene
Houston
09.2024 - Current
- Formulates and executes action plans addressing issues identified by business units, incorporating detailed workplans, issue logs, and progress reports.
- Contributes to health plan initiatives for designated products, aligning with organizational goals.
Create dashboards for senior management, providing actionable insights.
Seeks improvement opportunities by evaluating product performance and client feedback. - collaborate with various departments to implement product-specific business requirements aligning workflows with competitive landscapes and local market dynamics
Supervisor, Risk Adjustment Operations
Centene
Houston
10.2021 - 09.2024
- Directed workflow of operations team, ensuring compliance with performance standards and regulatory deadlines
- Monitored risk adjustment processes for completeness, accuracy, and alignment with Medicare/Medicaid regulations
- Evaluated business processes and implemented enhancements to improve scalability and quality
Risk Adjustment Coordinator II
Centene
Houston
10.2020 - 10.2021
- Managed state work pends, ensuring on-time completion and maintaining volume under 7%.
- Acquired medical records by engaging provider groups through targeted phone outreach.
- Resolved vendor requests by ensuring timely follow-up and clear communication.
Medical Claims Processor
Manhattan Life Insurance
Houston
07.2019 - 08.2020
- Precisely inputted and assessed data for claims and applications utilizing proprietary system.
- evaluated and processed insurance claims submissions (including dental, vision, cancer, or Medicare supplement) adhering to company policies, policy provisions, and state laws
Quality Improvement Specialist
Superior Health Plan
Austin
12.2017 - 06.2019
- Managed pends for states, ensuring timely completion and maintaining market volume below 7% to meet operational targets.
- Resolved outstanding vendor requests by communicating effectively with stakeholders to enhance collaboration and support.
- Acquired records by engaging provider groups through strategic phone calls to streamline information retrieval.
Education
Some College (No Degree) - Certified Medical Billing and Coding Specialist
Ashworth College
Norcross, GASome College (No Degree) - Medical Billing And Coding Certificate
The College of Health Care Professions
TXSkills
- Risk management
- Healthcare compliance
- Healthcare regulations
- Data analysis
- Process improvement
- Operations management
- Operational strategy
- Cross-functional teamwork
- Effective communication
Timeline
Manager, Risk Adjustment Operations
Centene
09.2024 - Current
Supervisor, Risk Adjustment Operations
Centene
10.2021 - 09.2024
Risk Adjustment Coordinator II
Centene
10.2020 - 10.2021
Medical Claims Processor
Manhattan Life Insurance
07.2019 - 08.2020
Quality Improvement Specialist
Superior Health Plan
12.2017 - 06.2019
Some College (No Degree) - Certified Medical Billing and Coding Specialist
Ashworth College
Some College (No Degree) - Medical Billing And Coding Certificate
The College of Health Care Professions