Tomeka Martin
Wellness Coach
Spotsylvania,VA
Summary
Results-oriented Analyst skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow and production by uncovering trends affecting business success. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Sr. Analyst Network Relations
Aetna Medicaid
Richmond , VA
02.2022 - Current
- Delivered in-depth training, imparting knowledge of best practices for protecting data and minimizing errors.
- Organized system infrastructure documentation and operating procedures, strengthening controls and enhancing overall performance.
- Managed customer relations by developing effective communications process.
- Research denied claims.
- Maintained energy and enthusiasm in fast-paced environment
- Worked with customers to understand needs and provide excellent service
- Conducted research, gathered information from multiple sources and presented results
- Collaborated with team members to achieve target results
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Used Microsoft Word and other software tools to create documents and other communications
- Proved successful working within tight deadlines and fast-paced atmosphere
Specialist,Quality Interventions/QI Compliance
Molina Healthcare
Richmond, VA
01.2021 - 12.2021
- Provider outreach to educate and assist with closing HEDIS gaps for medicaid members
- Medical Retrieval records
- Educate medicaid members about HEDIS gaps.
- Provided suggestions for and actively participated in improving sales, margins and execution of all programs
- Listened and responded to customer requests and forwarded necessary information to superiors
Quality Specialist
Magellan Health
Richmond, VA
04.2019 - 01.2021
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- QMR
- Audit providers personal care, respite, and personnel records
- Host clinic days and Providers outreach to educate and assist with closing HEDIS gaps for our members.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies
- Monitored product standards and quality-control programs
- Analyzed quality and performance data to support operational decision-making
GAP Recovery Navigator
Magellan Health
Richmond, VA
08.2016 - 04.2019
- Consulted with medical staff and ancillary department to eliminate barriers to delivery of care and identified service delivery problems and potential for patient management intervention.
- Developed care plan based on provider treatment plan, evidence-based chronic care guidelines and patient and family goals for patient.
- Assisted with and facilitated transition of care from hospitals, rehabilitation facilities and skilled nursing facilities to home.
- Connect clients with community-based services and resource agencies
- Provide evidence-base peer support services, such as WRAP and peer support Whole Health &Resiliency
- Serve as consumer advocate, share coping skills and provides recovery information for consumers.
- Used Microsoft Word and other software tools to create documents and other communications
- Maintained energy and enthusiasm in fast-paced environment
- Proved successful working within tight deadlines and fast-paced atmosphere
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Increased customer satisfaction by resolving issues
Customer Service Associate
Magellan Health
Richmond, VA
01.2016 - 08.2016
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Verified provider payment amounts
- Resolved customer product complaints Em pathetically and professionally
- Verified all required customer information for tracking purposes
- Fielded average of 20 calls per day related to claims and provider inquiries as well as crisis calls
- Submitted inpatient authorizations and assisted members in locating providers.
Assistant Transportation Coordinator
LogistiCare
Richmond, VA
02.2015 - 01.2016
- Provided timely transportation of diverse clients to healthcare facilities.
- Answered average of 200 calls per day addressing customer's inquiries
- Assisted members and providers with any transportation concerns.
- Coordinated transportation services with third party providers.
- Escalated all clients concerns for resolution
- Provided timely transportation of diverse clients to healthcare facilities
- Coordinated driver dispatch to accomplish daily delivery requirements
Education
No Degree - Community Health Worker
Piedmont Community College
Charlottesville, VA03.2020
No Degree - CDC National DPP Lifestyle Coach
University of Virginia
Charlottesville, VA03.2020
Skills
- Customer Monitoring
- Competitive Market Analysis
- Spreadsheet Development
- Industry Report Reading
- Business Analysis
Certification
- Community Health Worker
- CDC National DPP Lifestyle coach
- IPS Supported Employment
- Community Health Academy
- MCD Public Health
- REVIVE Facilitator
- Advance Directive Facilitator
- Notary Public 12/2022
- Registered Peer Recovery Specialist
- ASIST
- Mental Health First Aid
Timeline
Sr. Analyst Network Relations
Aetna Medicaid
02.2022 - Current
Specialist,Quality Interventions/QI Compliance
Molina Healthcare
01.2021 - 12.2021
Quality Specialist
Magellan Health
04.2019 - 01.2021
GAP Recovery Navigator
Magellan Health
08.2016 - 04.2019
Customer Service Associate
Magellan Health
01.2016 - 08.2016
Assistant Transportation Coordinator
LogistiCare
02.2015 - 01.2016
No Degree - Community Health Worker
Piedmont Community College
No Degree - CDC National DPP Lifestyle Coach
University of Virginia
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