Dr. Emmanuel Muro
Dodoma
Summary
Highly knowledgeable Quality Assurance Officer with background in maintaining and elevating company standards with strong familiarity in implementing quality assurance measures, conducting fraud examinations, and identifying process improvements for enhanced efficiency. Equipped with analytical skills, problem-solving abilities, and keen attention to detail which resulted in improved service provision by institution and stakeholders.
Overview
10
10
years of professional experience
Work History
Quality Assurance Officer
National Health Insurance Fund
Dodoma
06.2018 - Current
- I was part of the development and implementation of quality assurance standards for claim processing, verification, and fraud examination.
- Monitored compliance with established policies, procedures, and manuals for claims reimbursement.
- Analyzed data from claims and members to identify loopholes and committed fraudulent activities.
- Identified the root causes and control failure leading to fraudulent practices.
- Investigated customer complaints regarding services provided and ensured corrective action was taken promptly.
- Reviewed membership and claims reimbursement documents to uncover fraudulent activities, thus saving the institution from financial loss.
- Prepared detailed reports, detailing findings from fraud examinations conducted on members and service providers.
- Recommended corrective actions after uncovering fraudulent activities relating to membership and claims submitted by service providers.
- Advised management on changes needed to improve existing processes, or develop new ones.
- Participated in design reviews of new platforms and processes before implementation.
- Identified problematic areas that deviate from quality standards and recommended corrective actions.
- Worked closely with law enforcement agencies during investigations.
- Trained professionals and professionals in quality assurance methods and techniques of fraud detection.
- Managed fraud examination key performance indicators to ensure adherence to the institution's Antifraud SOP.
- Took part in the review of current manuals and policies.
Medical Officer
MASSANA HOSPITAL
DAR ES SALAAM
11.2016 - 06.2018
- Provided medical advice and support to patients, families, and healthcare personnel.
- Developed treatment plans for patients based on diagnosis and individual needs.
- Conducted physical examinations of patients and documented findings in patient records.
- Prescribed medications as needed for the treatment of various illnesses or diseases.
- Monitored patient progress and adjusted treatments accordingly.
- Performed minor surgical procedures such as suturing wounds or removing cysts or tumors.
- Coordinated with other healthcare professionals to ensure optimal patient care.
- Assisted in emergency situations by providing life-saving measures when necessary.
- Educated patients on preventative health care practices, nutrition, and lifestyle choices.
- Maintained accurate records of patient data including test results, diagnoses, treatments, allergies.
- Adhered to all safety protocols while performing medical procedures.
- Evaluated test results and implemented appropriate treatments.
- Facilitated referrals to specialists when necessary.
- Attended conferences relevant to area of specialty.
- Ordered laboratory tests or imaging studies as needed for diagnosis or treatment planning.
- Provided follow-up care for previously discharged patients.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Communicated with patients with compassion while keeping medical information private.
- Explained policies, procedures and services to patients.
- Kept informed of advances in medicine and computerized diagnostic and treatment equipment.
Intern Doctor
AMANA REGIONAL REFERRAL HOSPITAL
DAR ES SALAAM
10.2015 - 10.2016
- Assisted in developing patient care plans and providing follow-up care.
- Performed physical examinations, taking vital signs, and administering medications.
- Provided health education to patients on chronic diseases such as diabetes and hypertension.
- Reviewed medical histories of patients before appointments.
- Documented patient progress notes in the electronic medical record.
- Participated in interdisciplinary team meetings to discuss patient treatment plans.
- Assisted with minor surgical procedures such as suturing wounds or removing skin lesions.
- Ordered diagnostic studies, including X-rays and ultrasounds.
- Observed physicians during office visits and surgeries for educational purposes.
- Maintained accurate records of patient encounters in the EMR system.
- Assessed patients' needs for additional resources, such as home healthcare services.
- Consulted with specialists regarding complex cases when needed.
- Collected specimens for testing including blood samples or urine cultures.
- Utilized evidence-based guidelines when making decisions about patient care plans.
- Recorded patients' medical history, vital statistics, and test results in electronic medical records.
- Updated patient records about treatment and care.
- Ordered laboratory tests and imaging scans to complete further investigations.
- Monitored patients with acute conditions for changes, improvements, or need for intervention.
- Prepared patients for specific treatments.
- Delivered high-quality and compassionate treatment to patients under the direction of professionals.
- Maintained strict patient privacy and confidential patient information.
- Monitored treatment regimens to determine efficacy and adjusted according to results achieved.
- Referred patients to outside specialists or hospital admissions for more advanced care.
- Assisted professionals with educating patients and family members on medical conditions and treatment options.
- Advised patients about diet, nutrition, and other lifestyle behaviors to promote health and disease prevention.
- Referred patients with serious medical conditions and emergencies to higher hospitals for immediate care.
- Collaborated with other healthcare professionals to provide comprehensive patient care.
- Prescribed medications or treatment regimens to address patient conditions.
- Ordered and interpreted results of laboratory tests and radiographs.
- Improved patients' wellbeing by advising on medical and lifestyle issues impacting current health.
- Analyzed records, exam data and test results to inform diagnoses.
- Referred patients to medical specialists, social services or other necessary resources.
- Discussed histories and current symptoms or complaints with every patient.
- Admitted patients for hospital stays.
Education
CERTIFIED FRAUD EXAMINER
ASSOCIATION OF CERTIFIED FRAUD EXAMINERS
AUSTIN,TEXAS USA05-2021
M.D. - MEDICINE
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
DAR ES SALAAM11-2015
Skills
- Data analysis and interpretation
- Quality assurance processes
- Team Development
- MS Excel
- Evidence collection
- Interviewing techniques
- Document examination
- Investigative reporting
- Data Verification
Timeline
Quality Assurance Officer
National Health Insurance Fund
06.2018 - Current
Medical Officer
MASSANA HOSPITAL
11.2016 - 06.2018
Intern Doctor
AMANA REGIONAL REFERRAL HOSPITAL
10.2015 - 10.2016
CERTIFIED FRAUD EXAMINER
ASSOCIATION OF CERTIFIED FRAUD EXAMINERS
M.D. - MEDICINE
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES