Grace Segura
IL
Summary
Seeking a challenging position where I can utilize my skills and proven abilities with my personal, educational, and professional experiences. QUALIFICATIONS 20+ years in Healthcare field experience. Recognized for my outstanding managerial skills. Skilled in various clinical and administrative duties. Great time management and organizational skills, detail- oriented, focused, motivated, and able to adapt to new environments. Responsible team player, able to multi-task, and able to learn new concepts quickly. Proficient in MS Office skills: Word, Excel, Powerpoint, Outlook and Teams. Knowledge of multiple EMR systems. Knowledge of medical terminology, ICD-9/ICD-10 & CPT Codes, medical billing and coding.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Practice Performance Specialist (Remote)
Optum, UnitedHealth Group
, IL
01.2023 - Current
- Enhanced member engagement and outreach efforts.
- Increased compliance with medication adherence
- Implemented strategies and techniques to enhance star performance measures
- Engaged with pharmacies to fulfill members' medication needs
- Evaluated and analyzed medical records with remote EMR access
- Enhanced efficiency of processing electronic data entries.
- Navigate multiple systems across diverse provider networks
- Collaborated with providers to boost HEDIS star performance measures
- Assist with projects for retrieving HEDIS chart chase assignments
- Scheduled onsite visits and provided embedded support
Practice Manager
Itasca Foot and Ankle
Itasca, IL
07.2018 - 11.2022
- Motivated staff by offering direction and providing constructive feedback
- Supported entire practice's staff, which boosted efficiency and improved overall process flow
- Mentored and coached interns and newly hired team members on office procedures and computer systems
- Managed staff meetings with team building exercises
- Collaborated with marketing teams to leverage social media and other digital platforms for meeting promotion.
- Created content for our website, email campaigns and social media platforms to engage patients.
- Consulted with clinicians to develop business strategy
- Oversaw assistants, and office administrators
- Ordered supplies needed and kept tabs on inventory levels
- Complied with OSHA and HIPAA regulations
- Created and implemented policies and procedures for effective practice management
- Created and maintained electronic record management (EMR) systems to store data and develop reports
- Coordinated financial operations, budgeting, accounting, expenses and financial reporting tasks
- Checked entire office and waiting areas regularly to provide clean and organized surroundings
- Communicated with patients with compassion while keeping medical information private
- Explained policies, procedures and services to patients
- Recruited, hired and trained new medical and facility staff
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration
- Implemented policies and procedures to achieve financial goals while meeting patient and associate expectations
- Maintained credentialing contracts, licenses, and boards for physicians
- Processed payroll and responsible for AP/AR
- Managed and assisted with billing and coding along with claim management
- Point of contact for all communication.
Medical Office Manager
Dr. James J. Nuzzo D.P.M
Mt. Prospect, IL
07.2002 - 12.2018
- Credentialing for physicians, maintained licenses, and processed payroll
- Assisted doctors and staff with DME products, assisted in minor procedures/Surgeries / Draw up injections/ Wound dressing/ Casting / X-ray
- Managed practice, staff scheduling, set patient scheduling policy and surgery scheduling
- Oversaw and assisted with digital patient charting, data entry and administrative duties regarding insurance, billing, coding, claim management, and AP/AR and e-prescribe
- Performed data entry and processing into system databases and troubleshot minor computer issues
- Interviewed, hired and trained medical office teams and conducted performance reviews
- Maintained and managed filing, chart keeping and organizational systems for practice
- Developed plans to streamline patient flows, increase office and patient care efficiency and generate new revenues
- Supervised patient billing, collection and financial counseling and assisted with cash posting
- Pitched in to help with office tasks during busy periods and staff absences
- Trained employees on best practices and protocols while managing teams to maintain optimal productivity
- Analyzed internal processes and recommended and implemented procedural or policy changes to improve operations
- Liaised with customers, addressed inquiries, handled meeting requests and answer billing questions to provide outstanding customer care.
Eligibility Coordinator/ Administrative Support
Trizetto Group Inc
Westmont, IL
01.1999 - 06.2002
- Completed audits, researched rejected claims, and operated client capitation runs for accuracy
- Explained eligibility details and affordability options to patients with kindness and respect, and assigned PCP'S for members
- Entered client information and files into databases for further review and tracking
- Managed intake of new claims and performed routine follow-ups
- Explained reasons behind application denials and recommended further action
- Responded to client inquiries and concerns and escalated complex problems to department supervisors
- Maintained positive working relationship with fellow staff and management
- Proofread documents carefully to check accuracy and completeness of all paperwork.
Education
Bachelor of Science - Healthcare Management Currently
Morton College
Computer Electronic Engineering Technology
ITT Technical Institute
High School Diploma -
Morton East High School
Skills
- Managing Medical Practices
- Policy and Procedure Development
- Workflow Management
- HIPAA and OSHA Regulations
- Employee Performance Evaluations
- Employee Recruitment
- Hiring Decision Making
- Critical Thinking
- Time Management
- Employee Work Scheduling
- Verbal and Written Communication
- Payroll Administration
- Managing Files and Records Resource
- Point Of Care Marketing
- Healthcare Digital Marketing
- Networking with Healthcare Industry
- Performance Improvement
- Insurance Verification
- Inventory Management
- Healthcare knowledge
- Relationship Building
- Medical Terminology
References
References Available Upon Request
Affiliations
- District School Board Member for 15 years
Accomplishments
- Awards, Performance, Development, Team Contributor, Community Contributor, Customer Service, 5 Star Effort, Achievement-Q4 MAD Dash Winner
Certification
- Medicare and Retirement Certification Level 1,2,3
Timeline
Practice Performance Specialist (Remote)
Optum, UnitedHealth Group
01.2023 - Current
Practice Manager
Itasca Foot and Ankle
07.2018 - 11.2022
Medical Office Manager
Dr. James J. Nuzzo D.P.M
07.2002 - 12.2018
Eligibility Coordinator/ Administrative Support
Trizetto Group Inc
01.1999 - 06.2002
Bachelor of Science - Healthcare Management Currently
Morton College
Computer Electronic Engineering Technology
ITT Technical Institute
High School Diploma -
Morton East High School
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