Radiology and Pathology utilization management has become a top priority for Medical Schemes as verification of these accounts eliminates duplicate submissions and ensures correct billing practice. The main objective of Verirad is to offer Radiology and Pathology Management Service to Medical Schemes in order to reduce their expenditure in this field that comprises roughly 11% of Medical Scheme spend.• Ensure Regulatory and Statutory Compliance• Reduce radiology/pathology expenditure• Behaviour modification regarding practice billing• Data Analysis – trend identification and profiling of providers, members and referring doctors• Forensic Accounting Analysis and Duplicate Recovery on unmanaged claims• Financial and Clinical account auditing• Preferred Provider Consultation• Capitation Arrangement Advice• Risk share Arrangements• ICD10 - NHRPL X-WALK• Possible Hospital Acquired Infection identification• Working with existing HIV, Diabetic and Oncology management programs and identify non-registered beneficiaries• Many other determinants out of our developing database.

Supervision and Management: The ability to oversee and manage the daily work activities of the department, ensuring the team is productive and meeting goals in a timely and efficient manner.Professional Knowledge: Demonstrating specialized technical and scientific knowledge in the field of radiology/imaging services, acquired through professional or academic qualifications, and through extensive practical experience.Training and Education: Offering training and education to staff members to ensure they have the necessary skills and knowledge to perform their job duties effectively.Guidance and Support: Providing guidance and support to staff members in developing and implementing imaging protocols in the department.Policy Adherence: Ensuring compliance with professional standards, HMC policies, procedures, and guidelines, and in accordance with applicable Service Level Agreements.Flexibility: The ability to perform job duties in variable situations within clearly defined policies, principles, and objectives with direction.Communication: Effective communication skills to collaborate with team members, superiors, and other departments to ensure smooth and efficient operations of the Clinical Imaging Department.Problem Solving: The ability to identify and resolve issues or problems that arise in the department, making sound decisions and taking appropriate actions.Decision Making: The ability to make critical decisions in a timely and effective manner that are in the best interest of the department and the organization.Time Management: The ability to manage time effectively, prioritize tasks, and meet deadlines, ensuring that patients receive timely access to quality clinical imaging services.

CT Scanning(Siemens Sensation 64 MultisliceGE Lightspeed 64 MultislicePhilips Brilliance 64 Multislice)- Trauma (Brain / Spines / Extremities)- Oncology (Chest / Abdomen / Pelvis)- Angio (Brain / Extracranial Vessels /Thoracic / Abdominal / Outflow)- Cardiac CTGeneral Diagnostic Radiography- mobile radiography- Theatre radiography- Trauma radiography- Orthopaedic radiography- Fluoroscopy- Bone densitometryClinical Facilitator-Student orientation-Student clinical facilitation-New recruit orientation-Clinical professional development-CPD facilitator

As a Medical Undewriter, I have gained experience in :Data Analysis: The ability to collect, analyze, and interpret large amounts of data from historical claims utilization data to make informed decisions and recommendations.Report Writing: The ability to write comprehensive and detailed reports that provide clear insights and recommendations based on utilization and clinical trends.Database Management: The ability to develop, maintain, audit, and review functional databases to ensure consistency and accuracy.Clinical and Medical Knowledge: Developing a strong understanding of clinical and medical terminology, concepts, and best practices to make informed clinical and medical recommendations based on data summaries, trend analysis, financial analysis, and business analysis.Risk Assessment: The ability to provide support to rate development and risk management decision-making through timely and accurate clinical and medical analysis to ascertain future risks.Underwriting: Developing a deep understanding of underwriting practices and techniques, including clinical and medical underwriting for health and life products.Financial Analysis: The ability to perform financial analysis and trend analysis of data critical for decision-making in pricing and risk assessment selections.Coordination and Collaboration: The ability to coordinate with different departments and teams, such as wellness, medical, and case management, to address identified risks and develop comprehensive solutions.Research Skills: The ability to conduct research and analysis on Actuarial research and studies, as well as product development initiatives.Presentation Skills: The ability to prepare and deliver effective presentations to communicate findings, insights, and recommendations to cross-functional teams.Adaptability: The ability to perform other duties that may be assigned from time to time, demonstrating flexibility and adaptability to changing business needs.

As a pre-authorisation, I developed and refined the following skills:Communication: The ability to communicate effectively and professionally with clients, colleagues, and medical professionals, both in person and over the phone.Time Management: The ability to manage time effectively to meet daily targets and deadlines, as well as to prioritize tasks and handle multiple requests simultaneously.Attention to Detail: The ability to maintain accurate and detailed records of pre-authorization information and confirm scans according to set protocols.Customer Service: The ability to provide excellent customer service by answering all telephones according to set standards, transferring calls only when no further assistance can be rendered, and offering transfers to Smart Health Choice Line for members who need more medical information about medical procedures, etc.Medical Terminology: Developing a strong understanding of medical terminology to ensure that the reason for admission is appropriate and to request BHF/ICD and CPT and motivation letters on pre-authorization, when necessary.Problem-Solving: The ability to handle urgent queries and provide authorization numbers for cases that still need to be loaded.Product Knowledge: Developing a deep understanding of Discovery's products and services, as well as the standards and protocols of the call center, to provide accurate and relevant information to clients.Confidentiality: Maintaining confidentiality at all times to protect the privacy and security of clients' personal and medical information.Computer Skills: The ability to capture messages on the system and maintain accurate records of pre-authorization information, as well as to use software programs and databases effectively.Teamwork: The ability to work collaboratively with colleagues to meet targets and achieve business objectives, as well as to share knowledge and skills with team members.

As a Radiology Assessor, I have developed and refined the following skills:Radiology Billing and Coding: Extensive knowledge of radiology billing and coding, as well as a deep understanding of the RSSA, NHRPL, and ICD10 coding guidelines.Healthcare Administration: Experience in both private radiology practices and in an administrative or consulting capacity with various Medical Schemes/Administrators or Managed Healthcare Companies, which may provide a broader understanding of healthcare administration.IT Radiology Product: A thorough understanding of the IT Radiology Product and its rules, which are based on a combination of RSSA, NHRPL, and ICD10 coding.Error Prevention: In-depth knowledge of the common areas where erroneous billing and over-servicing occur in radiology practices, such as duplicate submissions and/or payments, up-coding of tariffs, tariff combinations, comparison views, unbundled group tests, overcharging of consumables and contrast medium, inappropriate tariffs, and increased utilization.Forensic Analysis: Knowledge of forensic analysis techniques used to identify and recover duplicate claims that have not been managed for the 3 years prior to the management of their Radiology claims.Compliance: Understanding the regulatory environment, including HIPAA and other relevant laws and regulations, to ensure compliance with all applicable rules and guidelines.Customer Service: Developing strong customer service skills to communicate effectively with clients, resolve their queries and provide timely and accurate information.Analytical Skills: Developing strong analytical skills to review, assess and verify radiology accounts and identify errors, inconsistencies and opportunities for improvement.

Interventional Radiology is dedicated to the development and application of imaging to guide minimally invasive techniques utilized in diagnosis and treatment of a wide variety of conditions. As an IR Tech at SKMC, I assisted Specialist Radiologists in handling and managing catheters, guidewires, stents, embolisation devices and drainages in Interventional Angiographic Procedures .

General Diagnostic RadiographyCT Scanning – Siemens Somatom 64 multisliceBone DensitometryMammographyTheatre radiographyMobile RadiographyClinical Tutor training Radiography Students