Keith Chimuzinga

Experience

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  PROGRESSIVE INSURANCE BROKERS (PRIVATE) LIMITED

  Jan 1995 - Sept 1998

  Claims Assessor

  • Obtaining all necessary information on claims for the purpose of completing processing.• Overseeing the entire claims assessment process, including benefit explanation.• Examining, inspecting, and assessing the damage and loss of insured properties and businesses; estimating insurance costs and inspecting insured properties in order to evaluate the conditions that affect underwriting standards.• Analyzing claims in order to determine the level of the organization’s liability, making approval or denial decisions regarding claims, and negotiating settlements with claimants in accordance with provided policy or guidelines. • Assisting underwriters and insurance agents in the field to investigate claims and determine the cost and extent of damages• Developing and maintaining a strong understanding of insurance policies and legal issues• Inputting claims into the computer system accurately• Contributing to the continuous development of the claims process by identifying and implementing several opportunities for the development of products and process improvement• Suspending claims that require further investigation in order to resolve them appropriately• Proactively seeking to clarify and resolve claims using the best method of communication and initiative• Protecting the interest of the insurance company when dealing with claimants.• Researching, detailing, and substantiating each part of a claim, including building damage, contents, and extra living expense claims; preparing detailed damages reports based on monthly insurance cost software for the purpose of making an offer of settlement to the insured.• Carrying out insurance transactions, such as responding to claims in a timely manner, filing paperwork, communicating with policyholders, investigating liabilities, notifying the insurer of a covered loss as defined under the insurance policy, and assessing damages. Show less

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  New Start Center, Harare

  Jan 1999 - Sept 2000

  HIV and AIDS Counselor

  • Conducting Pre-counselling and Post-counselling, educating clients on HIV, AIDS and STD’s and their implications through different programs & policies.• Responsible for assessment of risk of the disease at an early stage• Keep all the records, data about a patient confidential and safe• Compiling the statistics and report to the management.• Conducting testing services using ELISA and maintains a list of certifications of Rapid HIV Test.• Conducting workshops and education workshops in schools as part of the HIV and AIDS programs with donors (peer educator).• Responsible for assessment of risk of the disease at an early stage.• Provides unbiased information on HIV testing to his clients & explains the testing process in simple way.• Conducts a report of risk assessment in which report he explains the implications of risk behaviors to his clients.• Prepares a medical follow up for critical cases that have high risk of HIV infection.• Submitting monthly statistical report as required by the program supervisor to look after every client properly on time.• Responsible to meet work plans & goals on time for the development and implementation of organization’s strategies.• Performing other duties as assigned by the authorities of the clinic or employer. Show less

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  Chimhanda District Hosp, Mukonde Rural Clinic

  Jan 2000 - Oct 2008

  General Nurse; HIV Nurse Practitioner; TB Focal Person; PMTCT Focal Person

  • Diagnosing the disease by analyzing patient’s symptoms and taking required actions for his/her recovery.• Maintaining reports of patients’ medical histories; and monitoring changes in their condition.• Carrying out the requisite treatments and medications.• Directing and supervising Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs).• Checking the stock on a regular basis for maintaining the inventory level; and placing orders if required.• Changing patient’s medication as indicated by their conditions and responses.• Adhering with the protocols; norms; rules and regulations in order to maintain complete medical records.• Maintaining hygienic and safe working environment in compliance with the healthcare procedures.• Conducting research for improving the nursing practices and healthcare outcomes.• Providing instant care during medical emergencies; like car accidents; burns; heart attacks and strokes.• Discussing treatment with pharmacists and physicians in the critical cases.• Providing necessary guidance on health maintenance and disease prevention.• Keeping an eye on every aspect of patient care that includes physical activity plus proper diet.• Preparing patients for examinations, and assisting doctors during surgery.• Resolving patients’ problems and fulfilling their requirements by applying multifaceted team strategy.• Interacting with the healthcare teams for maintaining harmonious relationships.• Attending educational workshops for enhancing professional and technical knowledge.• Performing lab work and giving complete information to the physician about patient’s condition during anaesthesia.• Recommending drugs and other forms of treatment; like inhalation therapy; physical therapy; etc.• Provides high quality care to patients through use of nursing process.• Institute infection control measures.• Co-ordinates and supervises the health team activities; hold monthly meetings with them and act as Secretariat. Show less

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  Mugg & Bean

  Nov 2008 - Nov 2011

  • Planning; Implementing; Monitoring and Evaluating daily; monthly and yearly activities of the organization.• Monitoring and giving daily duties to waiters and staff.• Taking out daily stock (monitoring opening and closing stock using FIFO and LIFO).• Ensuring all waiters and staff are performing their responsibilities and meeting expectations: targets set.• Ensuring food quality; cleanliness and hygiene and guest satisfaction.• Ensuring customer's exceptional and excellent services all the time• Attending to customer's queries.• Training new waiters and other staff; recommending and making approval for them to work.• Doing staff appraisals; recognize and motivate members: coaching and training for operational excellence.• Assisting in increasing turnovers and profits through developing waiters and staff; suggesting marketing ideas and providing appealing restaurant service.• Maintaining the restaurant's standard of services all the time.• Strategic Consulting; including business plan and sale strategy development.• Reporting to the General Manager. Show less • Greet and escort customers to their tables• Present menu and provide detailed information when asked (e.g. about portions; ingredients or potential food allergies)• Inform customers about the day’s specials• Offer menu recommendations upon request• Up-sell additional products when appropriate• Take accurate food and drinks orders; using a Point Of Sale (POS) ordering software; order slips or by memorization• Communicate order details to the Kitchen Staff• Serving food and drink orders• Check dishes and kitchenware for cleanliness and presentation and report any problems• Arrange table settings and maintain a tidy dining area• Deliver checks and collect bill payments• Carry dirty plates; glasses and silverware to kitchen for cleaning• Meet with restaurant staff to review daily specials; changes on the menu and service specifications for reservations (e.g. parties)• Making menu recommendations; answering questions and sharing additional information with restaurant patrons.• Reporting to Floor Manager and the General Manager. Show less

  • Floor Manager

    Nov 2010 - Nov 2011

  • Head Waiter

    Nov 2008 - Oct 2010
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  Prime Cure Group (Pty) Ltd

  Dec 2011 - Dec 2015

  • Provide training on department Standard Operational Procedures and process flows and evaluate implementation and knowledge there off quarterly • Adding relevant information to the Induction manual for all new employees, train and evaluate knowledge there off quarterly• Provide In- and outbound call centre training with specific detail to SLA, evaluate implementation and knowledge there off quarterly• Write and then train all staff on new internal processes/SOP’s in the department, evaluate implementation and knowledge there off quarterly• Participate effectively in the company Enhancing Performance and Development program (EPD)• Manage HIV members disease with dignity and passion by providing high quality care, support and guidance• Empower our HIV members to live with dignity by providing them with knowledge and support• Guidance to providers with regard to treatment and support• Excellent professional working relationships with all designated service providers (DSP), members and Network providers. • Excellent professional relationships with non-DSP, non-Network providers and specialists• Excellent working relationship with any physician contacting the HIV Disease Management department• Oversee the correct and timeous management of pending registrations according to department SLA and manage ineffectiveness appropriately• Evaluate employee calls to determine that correct information/education is given to providers and members and manage shortcomings appropriately• Provide accurate and appropriate processes to effectively management complicated and non-complicated cases• Write Standard Operational Procedures for all processes within the department• Evaluate staff benefit knowledge and manage ineffectiveness appropriately• Write accurate monthly/quarterly reporting on staff performance, staff time management, and on clinical related information (adherence, non-compliance, lost to follow up members, etc) and provide solutions to short comings Show less • Implementation of Prime Cure DMP• Writing of Policies and Standard Operational procedures• Continuous training new and current staff on all areas pertaining to the HIVDMP• Liaise with internal and external customers• Liaise with internal departments• Counseling of members that are non-compliant to treatment• Registration of Disease Management Program (DMP) patients on MHS• Assist with tracking of defaulting members• Authorization of scripts on MHS system• Oversee all registrations for correctness and appropriateness• Authorization of pathology; GP visits and or any other services• Investigation of members' pattern with regards to doctor hopping; non-adherence to follow up visits; frequency of GP visits; and among others.• Application of clinical knowledge for effective and accurate ICD 10 and CPT4 coding of the patients' records.• Building relationships with Doctors discussing level of care and giving feedbacks on updates from Medical Aids.• Accurate and Timeous communication and follow up with medical aids and adhering to turnaround times to ensure approval of stay or procedure by medical aids• Demonstrate Netcare Value and Caring of Netcare way in all my behaviour.• Values: Caring; Truth; Dignity; Passion and Participation; and show respect; identity; dignity; compassion and appreciation Show less

  • Team Leader - HIV Department

    Apr 2014 - Dec 2015

  • Case Manager - HIV Department

    Dec 2011 - Apr 2014
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  HIV/AIDS Knowledge is Power

  Jan 2014 - now

  Founder; HIV Clinician

  ResponsibilitiesCollaborates in implementing the overall mission, vision, direction, strategies, budget priorities and operational plans for system-wide HIV care integration.Leads activities that will improve engagement and retention in care for PLWHA.Deploys all HIV-focused clinical and administrative staff to ensure timely and reliable access to primary and specialty care for patients within their communities.Collaborates with non-HIVKIP healthcare providers, public health entities and relevant community-based organizations as appropriate to achieve goals in region in accordance with health strategies.Achieves and assures standards of care required for patient-centered medical home certification for PLWHA and at-risk populations across the health system.Works with reports to ensure that the vision and mission of HIVKIP are consistent with System goals.Effectively communicates to key clinical and operational staff as well as external audiences.Develops and maintains effective working relationships with internal external stakeholders.Represents system HIV services to external agencies, community, public health, and HIV/AIDS service agencies.Supervises and assists clinical department heads to ensure that clinical and administrative practices support are compliant with HIVKiP and extramural regulatory policies and requirements.Assures cultural competent service that contributes to a positive patient experience.Monitors, evaluates ongoing operations and develops strategies to maintain sound operations.Oversees development and enforcement of policies and procedures that will improve patient care, increase proficiencies, efficiencies and departmental effectiveness.Works within system and external funding agencies to optimize extramural funding for programs.Oversees integration of values and visions of quality assurance into the operations for process improvement to achieve high reliability, maintain a culture of safety, ensure positive patient experience. Show less

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  Thebe Health Risk Management

  Dec 2015 - Oct 2017

  Team Leader - HIV Disease Management

  HIIV Disease ManagementDuties:o Ensuring compliance with agreed Service Level Agreements entered into with the Client.o Managing and controlling workflow and processes according to the SOPs.o System administration of scheme. o Quality management and control.o Project involvement and facilitation for scheme and non-scheme clients.o Compilation of monthly client reports.o Dealing with high level queries and resolving complex cases.o Development of protocols, processes and reports to enhance the effectiveness of the team.o Daily management of team and performance.o Report any System or Process problems and recommend possible solutions to enhance system or processes.o Monitor complaints, suggestions and compliments. o Maintain an up to date policy and procedure file (SOPs). o Uphold the Bill of Rights. o Set individual and team targets and conduct performance review to ensure compliance with call strategy and quality levels.o Delivering the project according to the quality management plan.o Provide leadership, coaching, appraisal, motivation and development and set KPIs.o Provide on the job coaching to address specific performance gaps (KPIs).o Performance improvement plans which will also include personal development plans (linked to Performance management).o Performance management i.e. ongoing evaluation and quality assessment, ratings from QA and formal appraisals.o Corrective action i.e. IR disciplinary procedure.o Time and attendance management including leave scheduling and absence management.o Ensure implementation of work plans in a way that maintains operational best practice and leads to continuous delivery improvement Show less

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  Stock Market College Pty Ltd

  Nov 2017 - Sept 2018

  Trade Marketing Consultant & Stock and Forex Trader

  Learning and knowing how to trade stocks, shares, forex, cryptocurrency, and binaryGetting educated on the various factors that impact stock prices, including economic and market indicators, company financials and stock market trends.Understating the risks involved in learning how to trade stocks, and recognizing what stock market categories work best for your unique needs. Speculating which way the currency will go next using techniques like technical analysis or fundamental analysis. Show less

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  Momentum TYB

  Nov 2018 - Oct 2019

  Clinical Care Co-ordinator

  • Proactively track and support patients as they go to and from specialty care, the hospital, and the emergency room.• Developing care plans to address patients’ personal health care needs and rearranging them as necessary when difficulties arise.• Follow-up with patients immediately after an emergency room visit• Help manage a patient upon hospital admission, including discharge planning, post discharge follow-up and assisting in medication reconciliation• Establish to social needs of the patients post discharge e.g. refer to social worker, communicate test results and their meaning to patients and their families - as needed• Guide the patient back to the general practitioner that is the original gatekeeper of the scheme as preferred provider.• Proficient in analyzing, trouble shooting, correcting and communicating claims payment statements, including all the relevant tariffs, to patients and providers should the need arise.• Provide care management services for high risk patients including care plan development and education services for both patients and their family members.• Collaborating with all the clinical functions (Hospital Risk Management, Disease Management, PBM, Provider relations) and the other client facing functions such as Fund Management and Member Support Consultants.• Visiting patients, checking on the care received and documenting accordingly.• Working with the care team to evaluate interventions and identify where and when further ones will be required. Assist with developing and accessing health interventions.• Management of potential high risk / high cost cases, including:o Development of report for quick identificationo Development of strategies to optimize clinical settingso Assist Case Management dept. with regard to discharge planning or downgrading the intensity of care.• Coordinating between the member as patient, the doctor (and specialist), the hospital and the Medical Schemes (Sisonke and Thebemed Medical Aid Scheme) Show less

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  Life Peglerae Hospital

  Mar 2020 - Dec 2023

  Clinical Bill Auditor

  Conducts review on the patients' cases documentation of any encounters to ensure coding accuracy and documentation adequacy. Wok collaboratively with coders/providers to improve revenue cycle integrity while seeking and identifying trends and opportunities for coding optimization. Regularly conduct coding reviews of CPT, ICD-10, and modifier utilization.Coordinates, schedules and performs reviews of professional services and documentation performed by LHC, service providers and abstracted by Revenue Integrity coders for quality.Provide feedback and focused educational programs on the results of auditing, review claim denials pertaining to coding, and implement corrective action plans.Evaluates clinical documentation to identify inconsistency or improvement opportunities that could impact reimbursement, revenue integrity, and/or reduce denials.Reviews charge information submitted by certified coders, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing is being performed in an accurate and timely manner and is supported by documentation.Prepares written reports of the audit findings to internal leadership, clinical leadership, and providers.Develops educational presentations, learning tools, and training material.Provides education to coders for appropriate CPT, ICD-10, and modifiers based on supporting documentation and LHC charge capture support.Seeks to establish collaborative relationships with coding staff, clinical providers, in the support of coding education and documentation adequacy.Assists in the development of corrective action plans and participates in compliance investigations as needed.Manages special projects individually or in collaboration with other departments.Track coding quality and documentation improvements to measure ROI, organizational growth and support of CPI initiatives. Show less