Lara Rael
@lararael
Clinical auditor with expertise in healthcare management and communication.
What I'm looking for
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
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.
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.
Customer Care Call Centre Agent
Momentum Metropolitan
Feb 2012 - Jul 2012 (5 months)
Managed telephonic and email queries in a call center environment, focusing on dispute resolution and completion of claim journals for various medical schemes. This role required strong communication skills and the ability to handle customer inquiries efficiently.
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
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
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.
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.
Availability
Location
Authorized to work in
Job categories
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