PhillipsHmoHead of Medical Operations and Quality Assurance
Aug. 2019 - Dec. 2022Lagos, Nigeria• As a pioneer management staff of the organization, I developed and implemented quality assurance systems and programs for effective continuous credentialing, assessment, monitoring and evaluation of over 800 hospitals within Nigeria in line with international best practices on managed care. • Conduction of risk assessment and profiling of prospective clients to determine the viability of their intended policy and the execution of monthly utilization review to ensure financial risk protection for the organization. • Project manager that led the team that designed an Enterprise Software hosted on Microsoft Azure Server for the effective end-to-end running of the organizational operations. Key modules include: Finance Module, CRM, Claims and Underwriting. The project was delivered within a record time of 8 weeks from information gathering to User Acceptance testing and Go-Live. • Continuously met and exceeded my core KPI by keeping the Medical Loss Ratio (MLR) of the organization below 60% of our gross revenue over the past 2 years. • I continuously maintain the financial credibility of our organization by ensuring strict adherence to our payment terms as referenced in our Service Level Agreement with our over 800 network hospitals. This is done by strict monitoring of the Claims submission, adjudication, and payment to ensure there is no violation of the contract. • Oversee care coordination, provider relations, claims administration, wellness programs, member services activities and client relationship management • Direct Supervision of over 25 staff.