Clinical Pre-Authorisation Consultant

Ananzi; Pretoria; On-site; ZAR 300,000 - 420,000; Full time

Job summary

A leading healthcare organization seeks a Clinical Pre-Authorisation Consultant to join their dynamic team. The ideal candidate will be a registered nurse with at least two years of experience in managed healthcare, responsible for processing pre-authorisation applications and maintaining service excellence. A strong focus on customer service, technical skills, and proficiency in clinical coding are essential for success in this role.

Qualifications

• Registered with South African Nursing Council (SANC).
• At least two years in managed healthcare or private hospital setting.
• Fluent in English and understanding of Afrikaans.

Responsibilities

• Process and evaluate pre-authorisation applications.
• Handle telephonic authorisations for healthcare services.
• Deliver outstanding service to members and providers.

Skills

Technical capabilities

Customer focus

Interpersonal abilities

Education

Degree or diploma in nursing

Grade 12 certificate

Job description

Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team.

If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply!

Key Responsibilities : Application Review : Process and evaluate pre-authorisation applications.Telephonic Authorisations : Handle pre-authorisations for hospital and radiology services through the call center.Data Entry & Verification : Accurately capture and verify clinical details, including ICD-10 and item codes.Membership Validation : Confirm membership status and available benefits prior to granting authorisation.Special Requests : Assess and process special pre-authorisation applications.Coding Accuracy : Apply appropriate coding before approving benefits.Clinical Interpretation : Analyse medical reports and doctors' motivations.Information Sharing : Provide patients and service providers with clear, relevant information on scheme rules, benefits, and approvals.Benefits Management : Approve benefits in line with benefit options and protocols to mitigate scheme risks.Record Keeping : Maintain accurate records of all transactions and documentation.Service Excellence : Deliver outstanding service to members and providers.Continuous Learning : Stay updated on scheme rules, benefit options, legislation, protocols, and system changes.Requirements : Education : Minimum Grade 12 certificate.Nursing Qualification : Degree or diploma in nursing; registered with SANC.Experience : At least two years in a private hospital or managed healthcare setting.Knowledge : Medical Schemes Act.Proficiency in CPT-4 and ICD-10 coding, with RPL knowledge.Skills : Strong technical and professional capabilities.Exceptional time and work management.Outstanding customer focus.Fluent in English (spoken and written) with understanding of Afrikaans.Proficient computer literacy.Interpersonal Abilities : Effective team collaboration.Conflict resolution skills.Flexibility : Willingness to cross-train in other managed care sections.How to Apply : Interested candidates who meet the requirements are invited to submit their CV and supporting documents to

• with the subject line "REF : Pre-Auth".

Please note : If you have not received feedback within two weeks of your application, consider your application unsuccessful.

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