LR
Open to opportunities

Lara Rael

@lararael

Clinical auditor with expertise in healthcare management and communication.

South Africa
Message

What I'm looking for

I seek a role that fosters collaboration and offers opportunities for professional growth in healthcare management.

I am a dedicated clinical auditor with over a decade of experience in healthcare management, specializing in hospital utilization and account auditing. My journey began at Momentum Metropolitan, where I have honed my skills in clinical analysis, dispute resolution, and effective communication with healthcare providers and members. I pride myself on my ability to ensure compliance with billing guidelines and to facilitate smooth interactions between patients and healthcare systems.

Throughout my career, I have demonstrated a commitment to excellence, achieving key performance indicators while maintaining high standards of confidentiality and professionalism. My educational background in Life Sciences, complemented by various certifications, has equipped me with a strong foundation in clinical auditing and healthcare operations. I am passionate about continuous learning and strive to motivate others in collaborative environments.

Experience

Work history, roles, and key accomplishments

MM
Current

Clinical Auditor

Momentum Metropolitan

Jul 2012 - Present (12 years 11 months)

As a Clinical Auditor, I manage hospital accounts for both mining and private medical schemes, ensuring compliance with billing guides and company protocols. My role involves extensive communication with case managers and members, dispute resolution, and facilitating appropriate payments. I also provide on-site support during wellness days and assist with HIV Aids treatment follow-ups.

MM

Specialist Pre-authorizations Service Agent

Momentum Metropolitan

Jul 2012 - Jul 2015 (3 years)

In this role, I evaluated members' referrals to specialists and managed telephonic and email communications with members and service providers. I ensured compliance with medical scheme rules and maintained high standards of service delivery within set KPIs.

SE

Tutor

Self Employed

Jan 2011 - Jan 2012 (1 year)

Provided tutoring in mathematics, science, and biology to high school students while pursuing my BSc. This role involved creating lesson plans, assessing student progress, and adapting teaching methods to meet individual needs.

Education

Degrees, certifications, and relevant coursework

University of South Africa logoUA

University of South Africa

Bachelor of Science, Biomedical Science

2020 - 2023

Graduated with a BSc in Life Sciences, specializing in Biomedical Science. The program included comprehensive studies in biological systems, laboratory techniques, and research methodologies.

Nelson Mandela Metropolitan University logoNU

Nelson Mandela Metropolitan University

Bachelor of Science, Biochemistry & Microbiology

2009 - 2010

Pursued a BSc in Biochemistry & Microbiology, gaining practical laboratory experience. The program focused on biochemical processes and microbiological techniques.

WS

Wittedrift High School

National Senior Certificate, General Education

2004 - 2008

Activities and societies: Best Science Residence Student, Top Science matriculant, Full Academic Colours.

Completed high school education with a strong focus on science subjects, achieving high marks in Computer Applications Technology, Mathematics, and Biology.

Tech stack

Software and tools used professionally

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Lara Rael - Clinical Auditor - Momentum Metropolitan | Himalayas