SILAS KWABENA AGYEKUM

• Performed root cause analysis to identify and resolve quality issues and defects.
• Collaborated with cross-functional teams to develop and implement process and system improvements.
• Conducted process and system audits to identify areas of improvement and enforce compliance with industry standards.
• Investigated customer complaints and performed corrective actions to resolve quality issues.
• Co-originating and providing guidance and information to heads of department and facility management teams.
• Promoting QA awareness and Conducting patient satisfaction surveys.
• Using facility data to improve quality of care.
• Identifying quality problems and drawing up action plans.
• facilitate trainings and awareness
• investigation of reported cases of co-payment, fraudulent or error claims,
• non-compliance with contractual obligations
• pre & post-credentialing and clinical audit monitoring
• claims verification support
• facility assessment and mapping
• review of M&E, claims, and credentialing & clinical audit reports
• special assignment from head office, MRO, Regional office

· Monitoring the implementation of quality activities.

· Producing/adapting/updating relevant local standards, guidelines, and protocols.

Disseminating information on quality assurance to staff

• Successfully managed team 42 staff, providing assistance and answering questions.
• Collaborated with director on process improvement initiatives to attain goals.
• Adhered to all applicable compliance and regulatory requirements.

● I am among team of clinicians mandated by executive management and departmental head to develop manual and electronic claim processing guidelines, standard operating procedures (SOPs), standard business rules for specific outpatient Ghana-diagnostic related groupings and other off and on-label claims processing protocols in line with the ministry of health directives.

● Supervising receipts, processing, and payment of claims for services rendered by healthcare providers, and in a timely manner as required in the claims processing guidelines.

● Sampling and reviewing vetted claim in or outside the clinician portal for quality and accuracy checks and make appropriate recommendations on assessment outcomes to my superiors. This is to ensure the efficiency and quality of services under the national and private health insurance schemes.

● Assisting vetting officers in handling difficult claims by offering clinical and/or professional expertise on the subject matter, whiles documenting such scenarios for future references and learning,

● Assisting in claims adjudication process through timely responses to claims queries from healthcare providers where necessary, and to protect the interest of both insured and insurance providers for sustainable national health insurance schemes.

● Vetting of claims when necessary, reviewing of vetting reports and ensuring that providers receive vetting reports in a timely fashion.

● Appraise performance of immediate subordinates and/or superiors, develop and implement career and professional development training modules, performance rewards modules in line with the HR policies and recommend disciplinary measures for staff of the respective department in accordance with the organization’s disciplinary code.

● I represent the organization on the technical working groups and committees of the organization and the ministry of health (MOH) to partake in series of workshops, trainings, and meetings of the various stages of projects, programs and activities implementations, assessment and evaluation, and policy document developments.

● I undertake any additional duties that are assigned to me by my superiors where necessary.

● Have and still serving on statutory working committees of the Authority internally and on the Ministry of Health