Consultant:Pre- Authorisation

PPS; Centurion; On-site; ZAR 300,000 - 400,000; Full time

Job summary

A healthcare service provider is seeking an analytical and detail-oriented Pre-Authorisation Consultant. The role involves overseeing Pre-Authorisation and case management processes. Requirements include a nursing qualification and experience in managed healthcare call centres. Ideal candidates will possess excellent communication skills and be able to work under pressure. This position is located in Centurion, Gauteng.

Qualifications

• Nursing qualification is essential.
• 10 years Pre-Auth experience if no clinical qualification.
• Experience in Renal Dialysis, Oncology, or Psychiatric environments is preferred.

Responsibilities

• Ensure successful and smooth Pre-Authorisation processes.
• Communicate effectively with members and service providers.
• Compile and submit detailed reports on costs and patient progress.

Skills

Analytical skills

Detail-oriented

Excellent communication skills

Conflict resolution skills

Time management

Computer literacy

Education

Nursing qualification

Clinical Medical Associate qualification

Emergency Services qualification

Tools

MS Office

Medical Administration systems

Job description

Job Description

An exciting opportunity for an analytical and detail-oriented Pre-Authorisation Consultant exists in the Hospital Benefit Management group. The successful candidate will utilize their Clinical, Pre-Authorisation, and Case Management experience to build effective relationships with members telephonically.

Applications are invited for the above-mentioned position, to be filled as soon as possible.

Requirements

• Nursing qualification.
• Clinical Medical Associate qualification.
• Emergency Services qualification or any other Clinical/Medical qualification.
• Previous exposure in a Managed Healthcare Call Centre.
• 10 years Pre-Auth experience if no clinical qualification.
• Experience in Renal Dialysis, Oncology, and/or Psychiatric environments is highly preferred.
• Exposure to Theatre and/or ICU in a private hospital is an advantage.
• Sound knowledge of ICD10 & CPT4 coding systems, Medical Aid Industry rules & regulations, ISO, and related legislation.
• Excellent business writing and communication skills with exceptional telephone etiquette.
• Strong organizational awareness to anticipate the impact of actions on other groups.
• Effective time management and good administrative skills.
• Conflict resolution skills and ability to work under pressure.
• Strong team player with results-driven attitude.
• Computer literacy (MS Office and Medical Administration systems).

Duties and Responsibilities

• Ensure successful and smooth Pre-Authorisation and case management processes via telephony, email, and online chat in a call centre environment.
• Adhere to Scheme Rules on all Hospital Authorisations and clinical updates.
• Proper allocation of facilities for members.
• Handle internal and external clinical queries effectively.
• Communicate with members and service providers regarding hospital utilization matters.
• Assist with health risk management and monitor hospital re-admissions.
• Compile and submit detailed reports on costs and patient progress to the Scheme.

Preference will be given to Employment Equity candidates.

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