Tomeka Thomas
Grand Prairie,TX
Every problem is a gift—without problems we would not grow.
Tony Robbins
Summary
Highly experienced professional with 20+ years in the healthcare industry recently displaced due to a Medicaid program acquisition. Seeking opportunity in an individual contributor role that will provide continued utilization of expertise, skills and experience with professional growth that allows for work life balance. AREA OF EXPERTISE Decision Making Collaborative Team Player Innovative/ Strategic Thinker Excellent Customer Service Skills Training and Mentoring Strong Verbal and Written Communication Case management Time Management Leadership and Management Research and Investigation Self Motivated and Detailed Innovative/ Strategic Thinker Strong Interpersonal and Organizational Skills Managed Care Proficient in managing schedules, administrative functions and employee training. Disciplined and organized leader with a strong call center background focused on customer relations and team leadership. Achievements include improved customer satisfaction scores, increased service quality and reduced call times. Forward-thinking professional adept at developing and implementing successful policies to meet changing demands. Goal-oriented Call Center Manager dedicated to building and overseeing first-rate call center teams. Encouraging leader with a demonstrated record of achievement in the managed healthcare industry.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Member and Provider Services Call Center Manager
The Cigna Group
Bedford, TX
01.2022 - 01.2023
- Oversight and management of operations for customer service members and provider call center with over 20 representatives performing activities during the STAR+PLUS Medicaid and MMP health plan run out in anticipation of call center closure
- Maintained required call center service level and metrics
- Reporting of call center call volume and service levels on a weekly and monthly basis
- Addressed and resolved escalated call issues and complaints
- Staff scheduling, time off requests, timesheet approvals, employee scheduled separations/terminations in addition to conducting individual and team meetings
- Assisted callers with claim processing and payment issue inquiries.
Health Services Technical Training Manager
The Cigna Group
Bedford, TX
03.2019 - 12.2021
- Managed direct reports of two trainers and two training and policy support analysts for STAR+PLUS and MMP health services
- Directed and assisted trainers with development, maintenance and updating of learning curriculum, reference materials, job aids and content for company products, processes and technologies
- Research and analyzed contracts and manuals to provide direction and assistance in development of health services departmental operational policies, processes and procedures
- Followed regulatory updates received from contractual parties and provided support to Health Services UM and Care Coordination teams to assure compliance with local, state, and federal regulations as well as standard operational structure across Medicaid business
- Maintenance of access provisions, data updates and changes to departmental resource depository.
Health Services Coordination Manager
The Cigna Group
Bedford, TX
05.2016 - 03.2019
- Managed a team of approx
- 35-39 telephonic care coordination service coordinators, administrative electronic record management staff and 3 supervisors
- Determined process improvement needs and conducted auditing of staff’s performance
- Collaborated with audit and compliance departments on conducting audits, determining root cause analysis and development of corrective action plans
- Ongoing evaluation of staff case assignments and workload
- Identified and provided ongoing performance coaching
- Conducted quarterly staff check in meetings and end of year performance evaluations including merit determinations
- Initiated and completed staff hiring process, performance improvement action plans and terminations as appropriate and necessary
- Attended organizational meetings with other departments, members, providers and vendors
- Attended quarterly member advisory group meetings to educate members on service coordination and care coordination
- Compiled and evaluated reports routinely and as needed to evaluate team and individual staff performance and metric levels
- Developed and mentored supervisory staff regarding management of direct report staff.
Health Services Manager
The Cigna Group
Bedford, TX
12.2013 - 05.2016
- Directly managed 22-25 staff members
- Evaluated work activities of health services specialist with roles in service coordination intake telephonic communication and Home and Community Based Services administration
- Established objectives and goals, audited performance and execution of roles and responsibilities
- Developed job aids, references guides and training materials
- Identified and provided ongoing coaching and training needs among staff members
- Conducted quarterly, semi- annual and annual staff performance evaluations
- Responsible for hiring, disciplinary action and terminations of staff as necessary
- Attended organizational meetings with other departments and interfacing with members and providers
- Represented the MCO’s health services department at meetings held by the Health and Human Services Commission within contracted service areas and in Austin
- Prepared, compiled and evaluated reports routinely to evaluate team and individual staff performance levels
- Acted as a departmental SME and collaborated with the department trainer in training development
- Acted as a designated department super user for testing of computer system updates and software changes
- Collaborated in developing department policies and procedures.
Health Services Supervisor
The Cigna Group
Bedford, TX
07.2012 - 12.2013
- Supervised service coordination care coordinators under the leadership of the care coordination manager
- Monitored team performance including goal setting, multi-source feedback, measurement, and performance related rewards
- Participated and assisted with resolution of member complaints and grievances
- Attendance of departmental meetings involving operations planning, monitoring and improvement with seeking solutions to decrease turnaround times, streamline work processes and work cooperatively with other departments and jointly provide quality and seamless customer service
- Established staff work schedules and assignments
- Identified and provided ongoing coaching and training needs for staff
- Conducted quarterly, semi- annual and annual staff performance evaluations.
Service Coordinator
The Cigna Group
Bedford, TX
11.2010 - 07.2012
- Successfully managed a case load providing care coordination to members with STAR+PLUS Medicaid obtaining access to providers, medical care and treatment as well as other services and benefits of coverage
- Assessed members needs utilizing health risk assessments and development of service plans
- Staff training and development of team reference material/SOP/job aids
- Effectively resolved member complaints
- Provider engagement.
Service Coordinator
United Health Group
Houston, TX
11.2006 - 10.2010
- Successfully managed a case load providing care coordination to members with STAR+PLUS Medicaid and dual eligible Medicare obtaining access to providers, medical care and treatment as well as other services and benefits of coverage
- Assessed members needs utilizing health risk assessments and development of service plans
- Authorized services, treatment and necessary medical equipment and supplies following health plan and Medicaid and Medicare guidelines
- Assist with training of new staff and development of team reference material/SOP/job aids
- Testing of system enhancements for IT implementation team
- Effectively resolved member complaints and concerns
- Provider engagement in addition to customer service internally and externally to other departments.
Operations Service Representative
United Health Group
Houston, TX
02.2006 - 11.2006
- Researched and resolved Medicaid and Medicare eligibility and enrollment issues
- Resolved and processed PCP assignment changes and errors
- Monthly membership reporting
- Attended community health fairs and events.
Patient Care Technician
Baylor Healthcare System/Baylor Specialty Hospital
Irving, TX
06.2003 - 05.2006
- Provided direct patient care under the supervision of Registered Nurse, Respiratory, Physical and Occupation Therapist
- Assisted in implementing plans of care to meet patient needs in addition to patient care that included examinations, procedures, and activities of daily living
- Obtained, documented and reported patient vital signs, weights, intake and output, diabetic finger sticks
- Respond to patients and visitors via telephone and call intercom system.
Education
Bachelor of Science - Health Studies/Community Health
08.2005
Associate of Science -
08.2003
Medical Assistant Diploma -
01.1998
Skills
- Microsoft Office-Outlook, Word, Excel, PowerPoint, Sharepoint
- Microsoft One Note, Visio, Teams
- Call conferencing- Web Ex, Zoom, Teams
- Verint Call Recording, Cisco Finesse
- Knowledge of claims processing and EOPs
- Experience with underserved, disabled and aged populations
- QNXT
- Typing speed 45-50 WPM
- Knowledge of CPT, ICD-9 and HCPC coding
- Applications on Salesforce
- Policy and procedure development
- Patient accounts/revenue cycle knowledge
- Employee Motivation
- Quality Controls
- Performance Improvements
- Report Preparation
- Escalation Management
- KPI Tracking
- Process Updates
- Performance Updates
- Project Planning and Coordination
- Team Coaching
- Staff Training
- Productivity Benchmarks
- Call Center Customer Service
- Productivity Standards
- Quality Control Optimization
- Information Tracking
- Technical Support
- Training Delivery
- Training Management
- Scheduling Proficiency
- Training Coordination
- Schedule Coordination
- Reporting Skills
- Quality Assurance
- High-volume call centers
- Hiring and onboarding team members
Certification
Case Manager (CCM)-The Commission for Case Manager Certification Valid 9/1/2020-5/31/2025 certification # 4249151 Health Education Specialist (CHES)-National Commission for Health Education Credentialing Issued October 2020 certification # 34517
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Member and Provider Services Call Center Manager - The Cigna Group
01.2022 - 01.2023
Health Services Technical Training Manager - The Cigna Group
03.2019 - 12.2021
Health Services Coordination Manager - The Cigna Group
05.2016 - 03.2019
Health Services Manager - The Cigna Group
12.2013 - 05.2016
Health Services Supervisor - The Cigna Group
07.2012 - 12.2013
Service Coordinator - The Cigna Group
11.2010 - 07.2012
Service Coordinator - United Health Group
11.2006 - 10.2010
Operations Service Representative - United Health Group
02.2006 - 11.2006
Patient Care Technician - Baylor Healthcare System/Baylor Specialty Hospital
06.2003 - 05.2006
Texas Woman’s - Bachelor of Science, Health Studies/Community Health
North Lake College/Dallas College - Associate of Science,
American Trade Institute - Medical Assistant Diploma,