SONIA SEGURA
Austin,Texas
Summary
Dynamic clinical leader with a proven track record at Texas Physician Health Program, excelling in staff training and compliance auditing. Expert in case management and conflict resolution, I enhanced program standards and participant care through effective service coordination and mentoring, driving team performance and ensuring adherence to regulations.
Overview
11
11
years of professional experience
Work History
Lead Clinical Coordinator
Texas Physician Health Program
Austin, USA
04.2022 - Current
- Engaged with Medical Director, staff, and participants to ensure quality care and uphold program standards.
- Educated participants on available services, rights, and responsibilities to enhance understanding.
- Collaborated with service providers to ensure continuity of care for all participants.
- Maintained accurate client records and documentation for compliance and accountability.
- Monitored progress and adjusted service plans to meet changing participant needs.
- Conducted research and reviewed participant files to create comprehensive case reviews.
- Boosted team performance through mentoring and close supervision of staff members.
- Delivered program support by recruiting, training, and overseeing a high-performing staff team.
Appeals and Grievances Analyst
Bright Healthcare
Texas, USA
08.2021 - 03.2022
- Reviewed and assigned backlog of over 1,200 cases at start of assignment.
- Collaborated with cross-functional teams on data analysis projects to enhance decision-making.
- Utilized software tools to process, analyze, and visualize large datasets efficiently.
- Worked on leadership projects, reporting findings for improved communication across departments.
Appeals and Grievances Coordinator
Baylor Scott & White
Austin, USA
01.2021 - 08.2021
- Presented weekly case reports to leadership, identifying trends in case volume and performance tracking.
- Maintained organized records of all active and closed cases for auditing and reference purposes.
- Ensured strict adherence to deadlines for initial complaint responses, appeals filing, and grievance resolutions.
- Facilitated communication between customers and relevant parties during the resolution process.
- Collaborated with internal departments to promptly resolve disputes and improve operational efficiency.
Compliance Coordinator
Superior Health Plan, Inc
Austin, USA
07.2014 - 09.2017
- Reviewed over 75 quarterly deliverables to ensure compliance with state agency standards.
- Analyzed data from internal reports, presenting quality issues to management for resolution.
- Reduced liquidated damages to only $500 for Q3 2016 through effective risk management.
- Promoted to Special Investigations Unit within five months due to outstanding performance.
- Served as liaison between corporate SIU and external organizations, such as OAG and HHSC for investigations and education.
- Recommended procedural improvements, updating workflows and related documents in C360 and SharePoint.
- Trained employees on compliance-related laws, regulations, and company policies.
Operator
Sonia's Mutterly Haven
Austin, USA
- Founded a pet sitting business to advocate for animal welfare and responsible pet ownership.
- Advised clients on needs, preferences, and budget considerations.
- Developed tailored care plans based on client consultations and animal requirements.
Education
Bachelor of Arts - Middle East And African Studies
Texas State University
San Marcos, Texas, TX12-2012
Skills
- Staff training and education
- Relationship management
- Case management
- Compliance auditing
- Service coordination
- Conflict resolution
- Team collaboration
- Documentation control
- Clinical data review
- Research coordination
- HIPAA compliance
Timeline
Lead Clinical Coordinator
Texas Physician Health Program
04.2022 - Current
Appeals and Grievances Analyst
Bright Healthcare
08.2021 - 03.2022
Appeals and Grievances Coordinator
Baylor Scott & White
01.2021 - 08.2021
Compliance Coordinator
Superior Health Plan, Inc
07.2014 - 09.2017
Operator
Sonia's Mutterly Haven
Bachelor of Arts - Middle East And African Studies
Texas State University