REGI ANTHONY MATELA

1. Managed clinic operations to optimise patient care and streamline service delivery.

• Give first aid treatment and immediate medical care to employees who get hurt or feel sick while working.
• Assess and monitor employees to decide if they need to be sent home or transferred to a hospital for further treatment.
• Dispense medicines safely and keep track of the clinic's medicine and first-aid supply inventory.
• Keep clean and private medical records for every employee, including daily clinic logs.

2. Facilitated health education sessions, enhancing employee wellness and awareness of health practices.

• Conduct health teachings and orientations to teach workers about nutrition, hygiene, stress management, and avoiding lifestyle diseases.
• Organise the Annual Physical Examination (APE) for all employees and help review their medical results.
• Share health flyers or emails to remind employees how to protect themselves against common seasonal sicknesses (like flu or dengue).

3. Ensured compliance with health regulations by preparing and submitting accurate health reports to government agencies.

• Prepare and submit health reports (like the Annual Medical Report) to government agencies like DOLE.
• Fill out SSS accident or sickness forms when a worker gets hurt on the job.
• Coordinate with the HMO provider to process employee medical consultations, laboratory requests, or letters of authorization (LOA).

4. Collaborated with safety officer to assess workplace hazards.

• Work closely with the Safety Officer to inspect the workplace for dangerous hazards.
• Investigate and log work-related accidents, writing down how the injury happened and how to prevent it from happening again.

1. Medical Review & Approvals (Utilization Review)

• Reviewed medical records and doctor's orders to determine medical necessity for treatments, surgeries, or hospital stays, ensuring compliance with clinical guidelines.
• Reviewed and assessed Letters of Authorization (LOAs) to determine approval or denial based on medical necessity. and coverage requests based on the patient's specific health insurance policy.
• Monitor ongoing hospital stays to evaluate if the patient still needs to be confined or if they can safely be discharged.

2. Case Management & Care Coordination

• Coordinate with hospital discharge planners and doctors to help arrange a patient's next steps (e.g., transitioning from the hospital to home care or rehab).
• Educated patients on their insurance benefits, clarifying coverage for treatments, medications, and equipment to facilitate informed decision-making.
• Facilitated connections for high-risk or chronically ill patients to specialised disease management programs offered by the insurance company. with special disease management programs provided by the insurance company.

3. Communication and Relationship Management

• Act as the primary point of contact between the insurance company, hospital billing/medical staff, and the patient.
• Resolved disputes and appeals by investigating denied insurance claims, effectively communicating with patients and hospital staff to achieve favourable outcomes.
• Maintain strong working relationships with accredited network hospitals and clinics.

4. Quality & Compliance Documentation

• Recorded all clinical decisions and review outcomes systematically in the insurance company's database to maintain accurate patient records. and review outcomes accurately in the insurance company's database system.
• Ensure strict compliance with data privacy laws (like the Data Privacy Act or HIPAA) when handling sensitive medical records.

1. Conducted blood collection procedures in clinical settings to ensure accurate specimen retrieval.

• Perform venipuncture and capillary punctures (needle sticks) on patients of all ages (infants to seniors) to collect blood samples.
• Identify patients correctly using multiple identifiers before drawing blood to prevent errors.
• Label blood tubes immediately and accurately at the bedside with the patient's name, ID number, date, and time.
• Prepare and organize specimens to be sent to the laboratory, making sure they are stored at the right temperature.

2. Patient Care & Safety

• Comfort and reassure anxious patients or those who have a fear of needles or blood.
• Monitor patients post-draw for dizziness, fainting, or prolonged bleeding, and provide immediate first aid if needed.
• Follow strict infection control rules (using PPE and disposing of used needles safely in biohazard sharps containers).

1. Clinic Management & Patient Care

• Give first aid treatment and immediate medical care to employees who get hurt or feel sick while working.
• Assess and monitor employees to decide if they need to be sent home or transferred to a hospital for further treatment.
• Dispense medicines safely and keep track of the clinic's medicine and first-aid supply inventory.
• Keep clean and private medical records for every employee, including daily clinic logs.

2. Health Teachings & Employee Wellness

• Conduct health teachings and orientations to teach workers about nutrition, hygiene, stress management, and avoiding lifestyle diseases.
• Organize the Annual Physical Examination (APE) for all employees and help review their medical results.
• Share health flyers or emails to remind employees how to protect themselves against common seasonal sicknesses (like flu or dengue).

3. Government Compliance & Administrative Tasks

• Prepare and submit health reports (like the Annual Medical Report) to government agencies like DOLE.
• Fill out SSS accident or sickness forms when a worker gets hurt on the job.
• Coordinate with the HMO provider to process employee medical consultations, laboratory requests, or letters of authorization (LOA).

4. Workplace Safety Coordination

• Work closely with the Safety Officer to inspect the workplace for dangerous hazards.
• Investigate and log work-related accidents, writing down how the injury happened and how to prevent it from happening again.