Tarey Bouverie
Durban,Greenwood Park
Summary
Results-driven Hospital Benefits Specialist with 10+ experience in delivering successful application of clinical and coding knowledge. I am interested in Hospital Benefit Specialist, Case Manager and Enrolled Nursing opportunities. I have a proven track record of bridging the gap between patients and medical insurance. I am skilled in aligning protocols, analysing data, and have effectively communicated with clinical staff, non-clinical staff and patients. I have worked to continually improve processes, improve relationships with stakeholders and drive customer satisfaction. I am passionate about using my skills to deliver excellent solutions that solve or simplify a problem.
Overview
12
12
years of professional experience
Work History
Hospital Benefit Specialist
Discovery Health
01.2020 - Current
- Managing the risk relating to in hospital admissions, through the application of clinical and coding knowledge and aligning to protocols, legislation, standard operating procedures (SOP’s), service level agreements (SLA’s) and the member’s benefit structure
- The role applies to working in various settings, predominantly casualty
- It is anticipated that the risk purpose will also extend into the general ward and high care/ICU settings as needed
- Coordinating the care of certain patients who are vulnerable to care gaps during transitions particularly entry into hospital through to the emergency room, and discharge from hospital
- The populations most vulnerable to gaps in care during transitions include clinically high risk patients; patients undergoing major surgical procedures; and patients with low socio-economic circumstances
- My job requires on-site case management within the Hospital setting.
Case Manager
Discovery Health
07.2015 - 01.2020
- Facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans, level of acuity appropriateness
- Building relationships with Doctors, patients as well as the multi-disciplinary team
- Assisted with holistic case management with regards to initiating discharge planning, managing length of stay for admissions.
Pre- Authorisations consultant
Discovery Health
05.2014 - 06.2015
- This role included delivering of service to all Discovery Health Members, Providers, Employer groups, Hospitals, and Brokers by supporting and fully resolving their queries through various servicing channels, primarily over the telephone
- To effectively manage the risk of in-hospital admissions by using your clinical knowledge and integrating this with your understanding of the benefits of the scheme and ensuring accurate information regarding funding.
Volunteer
Non-profit organisations
01.2018 - Current
- Volunteer work done in an old age home with caring for the frail, assisting them with their basic needs
- Helping the frail with mobilising, have an affinity with older people, high empathy towards the elderly as well.
Surgical One
Netcare Umhlanga Hospital
01.2012 - 04.2014
- Providing direct nursing care to patients, including administering medications, wound care, dressings, and charting all progress over time
- Performing physical examinations and other diagnostic tests and investigations to identify the cause of the patient’s illness or condition
- Providing basic nursing care to patients in a variety of health, age, community settings under the supervision of Registered Nurses.
Education
Enrolled Nursing Auxiliary - Course R2175 -
Netcare Education
Enrolled Nurse -
Netcare Education
High School Diploma -
Ridge Park College
First Aid-Level 1 -
Netcare Education
Skills
- Clinical coding
- Benefits Administration
- Risk Management
- Relationship Building
- Benefits Explanation
- Benefits Interpretation
- Case Management
- Verbal and Written Communication
- Documentation and Reporting
- Compliance Reporting
- Attention to Detail
Additional Information
A detailed description of my current role and previous employment:
My role is maintaining the Risk of the fund as well as putting my clinical experiences into play when updating in hospital events for the members as well as dealing with Doctors and providers.
I deal with all escalations at my facility from risk, providers as well as internal requests.
I will do very well in the role that I am applying for as I will be able to assess patients holistically as well as assist in the rehabilitation process as I do have experience on this from my current role as well as experiences from the acute setting. I am an onsite case manager at the Hospital and therefore update all the Discovery Health patient’s cases. I also assist the members with all their queries including claims, the use of the correct benefits as well as in hospital cover and care.
Discovery Health ensures that we are up to date with regards to our standard coding guidelines which we have been taught on, tested on as well as constantly upskilled. I am able to assist with coding, claim queries, clinical knowledge as well as risk management. I am a very fast learner, passionate about helping others and will always try my very best to provide a holistic approach with all patients.
I had previously participated in mentoring, auditing cases from mentees as well as coaching for my mentees. My current role encourages me to interact with people which is something that I enjoy and I strive to do my best at all times.
I have taken part in a discharge planning pilot from March 2020 to December 2020 which included liaising with doctor’s, family in assisting with the discharge planning process. I have done complex case management throughout this process as well preventing readmissions.
Discovery Health is a medical aid based in South Africa which assists with medical insurance, gap cover as well as vitality which is encouraging our members to be heathier and take care of their health needs.
Timeline
Hospital Benefit Specialist
Discovery Health
01.2020 - Current
Volunteer
Non-profit organisations
01.2018 - Current
Case Manager
Discovery Health
07.2015 - 01.2020
Pre- Authorisations consultant
Discovery Health
05.2014 - 06.2015
Surgical One
Netcare Umhlanga Hospital
01.2012 - 04.2014
Enrolled Nursing Auxiliary - Course R2175 -
Netcare Education
Enrolled Nurse -
Netcare Education
High School Diploma -
Ridge Park College
First Aid-Level 1 -
Netcare Education
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