Adelaide Mokone
Pretoria North
Summary
Detail-oriented Medical Bill Review Officer with proficiency in reviewing medical invoices and assessing accident-relatedness. Utilises extensive nursing background to ensure accuracy and appropriateness in claims. Leads and mentors teams to enhance operational performance and client satisfaction. Motivated professional demonstrating strengths in healthcare management and patient advocacy. Adapts to diverse challenges through effective communication and problem-solving skills. Committed to delivering high-quality service and driving positive outcomes in healthcare environments. Bringing strong interpersonal and communication skills, with knack for problem-solving and adaptability. Proven ability to work collaboratively in team environments while maintaining high level of organisation and attention to detail. Eager to contribute enthusiasm and commitment to achieving organisational goals. Good with patient assessment and emergencies.
Overview
2
2
Languages
17
17
years of professional experience
Work History
Medical bill review officer
Road Accident Fund
Pretoria, Hatfield
08.2016 - Current
- Review review medical invoices and preauthorization quotations for the fund to check and assess for accident relatedness, appropriateness and reasonability.
- Executed nursing duties, leveraging skills from intensive care and trauma nursing to ensure optimal patient care.
- Supervised and oriented team of officers, providing leadership and guidance to enhance operational efficiency.
- Respond to emergency calls for service, providing timely assistance and support to individuals in distress.
Professional Nurse
Netcare Sunninghill Hospital
Sunninghill, Johannesburg
09.2015 - 07.2016
- Worked as a Neonatal Intensive care nurse, duties included caring for newborn babies and premature babies.
- Administering medications orally, intravenously and intramuscularly.
- Monitored and adjusted stock levels of ward supplies to ensure availability for patient care. of ward supplies, ordering new stock to avoid shortages impacting patient care.
- Advocated for patients' rights and wellbeing, acting as a liaison between patients, families, and healthcare providers.
- Managed the administration of patient records, ensuring accuracy and confidentiality in line with data protection regulations.
- Maintained a safe, clean, and comfortable environment for patients, adhering to infection-control policies.
Professional Nurse
Right to care NGO
Freetown , Sierra Leone
01.2015 - 03.2015
- Assisted in combating the fight against Ebola virus, worked in the Ebola treatment centre ICU and High care.
- Managed stock levels of ward supplies, ordering new stock to avoid shortages impacting patient care.
- Advocated for patients' rights and wellbeing, acting as a liaison between patients, families, and healthcare providers.
- Maintained a safe, clean, and comfortable environment for patients, adhering to infection-control policies.
- Managed the administration of patient records, ensuring accuracy and confidentiality in line with data protection regulations.
- Administered oral, topical and intravenous medications based on patient symptomatology and treatment plans.
- Utilised infection control measures to maintain a safe and clean environment for patients and staff.
- Conducted patient assessments to identify care needs, preferences, and potential risks.
- Delivered emergency care and first aid to stabilise patients during critical situations.
- Supervised, trained and mentored new nurses on nursing requirements and procedures.
- Conducted wound care management, applying dressings and monitoring for signs of infection or complications.
- Administered medications and treatments to patients following prescribed healthcare plans.
HIV case manager
GEMS administered by Primecure Netcare
Sunninghill, Johannesburg
09.2013 - 12.2014
- Collaborated with team members to achieve target results.
- Client assessment, care planning and treatment monitoring.
- Approving quotations as pre-authorisation.
- Managed complaints with calm, clear communication and problem-solving.
- Achieved service time and quality targets.
- Engaged with customers to better understand needs and deliver excellent service.
- Monitoring and managing side effects of treatment.
- Handled customer concerns and escalated major issues to supervisor.
- Trained and mentored employees to maximise team performance as a Team Leader.
Professional Nurse
Charlotte Maxeke Academic Hospital
Parktown, Johannesburg, South Africa
01.2010 - 07.2013
- Managed stock levels of ward supplies, ordering new stock to avoid shortages impacting patient care.
- Worked at a Trauma High care unit for babies and children up to the age of 16 years.
- Advocated for patients' rights and wellbeing, acting as a liaison between patients, families, and healthcare providers.
- Maintained a safe, clean, and comfortable environment for patients, adhering to infection-control policies.
- Managed the administration of patient records, ensuring accuracy and confidentiality in line with data protection regulations.
- Administered oral, topical and intravenous medications based on patient symptomatology and treatment plans.
- Utilised infection control measures to maintain a safe and clean environment for patients and staff.
- Conducted patient assessments to identify care needs, preferences, and potential risks.
- Delivered emergency care and first aid as required, acting quickly to stabilise patients.
- Supervised, trained and mentored new nurses on nursing requirements and procedures.
- Conducted wound care management, applying dressings and monitoring for signs of infection or complications.
- Delivered specialised nursing care tailored to the unique needs of patients with chronic and acute conditions.
- Kept unit and stations well-stocked with necessary supplies for timely clinical care.
- Administered medications and treatments to patients following prescribed healthcare plans.
- Educated patients and their families on disease prevention and health maintenance practices.
- Collaborated with multidisciplinary team members to plan and implement patient care plans effectively.
- Administered CPR following Basic Life Support for Health Care Provider during emergency cases to patients undergoing cardiac arrest.
- Worked part time at a Trauma and ICU for adults and children in Sunninghill Netcare Hospital, Waterfall Netcare Hospital and Carstenhof Life Hospital.
Education
Higher National Diploma - Public Administration
Regenesys Business School
Sandton, GP01-2022
Certificate of Higher Education - Project Management
Enterprices at University of Pretoria
Pretoria, GP01-2017
Diploma of Higher Education - Diploma in Nursing
SG Lourens Nursing College
Pretoria, GP01-2010
GCSEs - Senior certificate
Tlokwe Secondary School
Potchefstroom, NW01-2003
Skills
- Medical coding
- Claims review
- Data analysis
- Patient advocacy
- Healthcare management
- Emergency response
- Client relationship management
- Problem solving
- Conflict resolution
- Communication skills
- Risk assessment
- Teamwork
- Microsoft Office proficiency
- Report-writing
- Informed decision making
- Critical decision making
- Strategic planning
- Attention to Detail
- Patience and tolerance
- Service commitment
- Empathy and compassion
- Public trust building
- Responsive action
- Conflict de-escalation tactics
- Maintaining confidentiality between health care provider and the client
Languages
English
Advanced
C1
Afrikaans
Intermediate
B1
Timeline
Medical bill review officer
Road Accident Fund
08.2016 - Current
Professional Nurse
Netcare Sunninghill Hospital
09.2015 - 07.2016
Professional Nurse
Right to care NGO
01.2015 - 03.2015
HIV case manager
GEMS administered by Primecure Netcare
09.2013 - 12.2014
Professional Nurse
Charlotte Maxeke Academic Hospital
01.2010 - 07.2013
Higher National Diploma - Public Administration
Regenesys Business School
Certificate of Higher Education - Project Management
Enterprices at University of Pretoria
Diploma of Higher Education - Diploma in Nursing
SG Lourens Nursing College
GCSEs - Senior certificate
Tlokwe Secondary School