Summary
Overview
Work History
Education
Skills
Timeline
SeniorSoftwareEngineer

Phatiswa Masimini

East London

Summary

Dynamic healthcare professional with extensive experience at Road Accident as a Medical Bill Reviewer. Proven analytical skills in assessing medical claims and ensuring compliance, while fostering teamwork and collaboration. Recognized for implementing cost-saving initiatives and enhancing stakeholder engagement, driving efficiency in billing processes and improving patient outcomes.

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

Overview

18
18
years of professional experience

Work History

Medical Bill Reviewer

Road Accident
04.2014 - Current
  • Assessing appropriateness , reasonability and authenticity of bills
  • Application of ICD 10 and CPT coding
  • Ensuring that services and treatments claimed are accident related
  • Assess and compile bill review report on past medical expenses and supplier claims
  • Stakeholder engagement
  • Conducting Medical injury assessments and undertaking recommendations
  • Drafting of specific undertaking for future medical expenses
  • Incorporate tariffs , cost savings initiative recording
  • Bill review payment verification
  • Checking duplicate claims and authenticity of medical records
  • Claims view recording on all claims assessed
  • Led team to meet project deadlines, ensuring tasks were delegated effectively.
  • Resolved customer complaints, restoring confidence in services.

Registered midwife/Primary Care Registered Nurse

Nontyatyambo Community Health Centre (Department of Health)
06.2011 - 03.2014
  • Assisted mothers with breastfeeding, self-care and postpartum healthcare.
  • Offered primary care to expecting mothers and newborn infants.
  • Fostered strong relationships with community organizations to provide resources and support services for pregnant women in need of additional assistance.
  • Handled labor and delivery for moms choosing alternative birth methods.
  • Diagnosed and treated patients with high-risk complications.
  • Collaborated with multidisciplinary teams to develop evidence-based guidelines for best practice in midwifery care.
  • Served as a mentor for student midwives by sharing clinical expertise, providing constructive feedback, and modeling excellence in the practice of midwifery.
  • Coordinated care with physicians, nurses, and other healthcare professionals as needed during complex or high-risk births to ensure optimal outcomes for mother and baby.
  • Conducted community outreach events promoting preventive health measures such as vaccinations, screenings, and lifestyle modifications to reduce risk factors for chronic illnesses.
  • Streamlined communication between healthcare team members, ensuring timely updates on patient progress and treatment plans.

Psychiatric Registered Nurse

Fort England Psychiatric Hospital
06.2009 - 05.2011
  • Explained useful coping methods to relieve depression and anxiety.
  • Provided direct quality care to patients by monitoring, recording and evaluating psychiatric conditions.
  • Advocated for and strived to protect health, safety, and rights of patient.
  • Monitored vital signs, nutritional intake and signs and symptoms of complications to report deviations to supervisor.
  • Coordinated with medical and paramedical professionals to provide appropriate input and effectively formulate and implement treatment plans for patients.
  • Conducted therapy for mentally ill patients in group and individual settings to assist patients in achieving normalcy.
  • Administered medication and treatments to patients to observe and record responses.
  • Built trust with patients from various cultural backgrounds through culturally competent care practices tailored to individual needs.
  • Contributed to improved team morale by demonstrating a positive attitude, supporting colleagues during challenging situations, and celebrating shared successes.
  • Improved patient outcomes by developing and implementing tailored nursing care plans for individuals with psychiatric disorders.
  • Enhanced treatment efficacy by collaborating with interdisciplinary teams to provide comprehensive mental health care.
  • Optimized clinical decision-making by conducting thorough psychosocial assessments upon admission and throughout patients'' stays.
  • Mentored nursing students during clinical rotations at the psychiatric facility, sharing knowledge and expertise while promoting their professional growth.
  • Developed strong working relationships with mental health community partners, facilitating seamless transitions of care for patients upon discharge from the facility.

Field Nurse

Sunflower Hospice
03.2009 - 05.2009
  • Developed individualized care plans to address specific needs of each patient, promoting independence and selfcare.
  • Streamlined documentation processes, ensuring accurate patient records and efficient communication between healthcare providers.
  • Established realistic, measurable and observable goals consistent with patients' diagnosis.
  • Educated patients and caregivers on disease processes, medications, plans of care and individualized treatment plans.
  • Reduced hospital readmissions through thorough patient education and timely follow-up visits.
  • Provided emotional support to patients and families during difficult situations, fostering trust and open communication.
  • Performed routine physical assessments, identifying changes in health status and adjusting care plans accordingly.
  • Conducted regular home safety assessments to minimize fall risks and ensure a secure environment for recovery.
  • Managed wound care effectively, preventing infection and promoting proper healing techniques.
  • Administered effective nursing care to ill, injured, convalescent and disabled patients.
  • Assisted in the development of clinical policies and procedures to enhance overall field nursing practice standards.
  • Educated family members and caregivers on patient care instructions.
  • Provided skilled, timely and level-headed emergency response to critically-ill patients.
  • Collaborated with interdisciplinary teams for comprehensive care plans, facilitating optimal patient recovery.

Community Service Nurse

Department of Health(Andries Vosloo Hospital)
03.2008 - 02.2009
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Provided emotional support to patients'' family members during critical incidents, strengthening overall trust in the healthcare team.
  • Performed routine wound care and dressing changes on schedule.
  • Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
  • Reduced medication errors through thorough double-checking of prescriptions and dosages.
  • Educated patients on disease management, self-care techniques, and wellness strategies to improve long-term health outcomes.
  • Utilized strong clinical judgment in prioritizing patient needs during high-stress situations, ensuring optimal outcomes.
  • Created an efficient shift handover process which improved continuity of care between nursing shifts.
  • Consistently adhered to strict safety guidelines while administering medications or performing invasive procedures.
  • Promoted a safe and comfortable healing environment by addressing patient concerns promptly and professionally.

Education

Diploma in Nursing Science (Advanced Diploma) - Nursing

Lilitha Nursing College
East London, South Africa
07-2028

Intermediate ICD10 Code Certificate - Medical Coding

Africode
Pretoria, South Africa
10-2022

Practical Labour Law - Law

Nelson Mandela University
Gqeberha
09-2022

AMAGUIDE Certificate - Medical Impairment Assessment

Foundation For Professional Development
Pretoria
07-2019

Postgrad Diploma in Programme Management - Business Administration And Management

Cranefield College
Midrand, South Africa
09-2018

Basic ICD 10/CPT Training - Medical Coding

Wits University
Johannesburg, South Africa
03-2018

Skills

  • Teamwork
  • Teamwork and collaboration
  • Customer service
  • Problem-solving abilities
  • Analytical thinking
  • Time management
  • Multitasking
  • Excellent communication
  • Organizational skills
  • Self motivation

Timeline

Medical Bill Reviewer

Road Accident
04.2014 - Current

Registered midwife/Primary Care Registered Nurse

Nontyatyambo Community Health Centre (Department of Health)
06.2011 - 03.2014

Psychiatric Registered Nurse

Fort England Psychiatric Hospital
06.2009 - 05.2011

Field Nurse

Sunflower Hospice
03.2009 - 05.2009

Community Service Nurse

Department of Health(Andries Vosloo Hospital)
03.2008 - 02.2009

Diploma in Nursing Science (Advanced Diploma) - Nursing

Lilitha Nursing College

Intermediate ICD10 Code Certificate - Medical Coding

Africode

Practical Labour Law - Law

Nelson Mandela University

AMAGUIDE Certificate - Medical Impairment Assessment

Foundation For Professional Development

Postgrad Diploma in Programme Management - Business Administration And Management

Cranefield College

Basic ICD 10/CPT Training - Medical Coding

Wits University

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Phatiswa Masimini