Consultant:Pre- Authorisation

PPS Recruitment; Centurion; On-site; ZAR 350,000 - 500,000; Full time

Job summary

PPS Recruitment is assisting in sourcing an analytical Pre-Authorisation Consultant for the Hospital Benefit Management group in Centurion. The role focuses on accurate clinical, pre-authorisation and case management, delivered via telephone, email and online chat to our members.

The successful candidate will leverage clinical experience and strong communication to build relationships with members while ensuring adherence to Scheme Rules and efficient patient pathways.

Qualifications

• Nursing qualification and a clinical/medical qualification.
• Experience in a Managed Healthcare Call Centre.
• Knowledge of ICD10, CPT4 and medical aid regulations.

Responsibilities

• Handle Pre-Authorisation and case management telephonically in a call centre.
• Adhere to Scheme Rules on hospital authorisations and updates.
• Allocate facilities for members accurately.
• Handle internal and external clinical queries.
• Communicate with members and service providers on utilisation matters.
• Assist with Health Risk Management and readmission management.
• Prepare and submit detailed cost and progress reports.

Skills

Communication

Organisational awareness

Time management

Conflict resolution

Team player

Administration skills

Call centre experience

MS Office

Medical administration system

Education

Nursing qualification

Emergency Services / Clinical qualification

Tools

MS Office

Medical administration system

Job description

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

Minimum Requirements

• Nursing qualification.
• Emergency Services qualification or any other Clinical/Medical qualification
• Previous exposure in a Managed Healthcare Call Centre
• Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred.
• Exposure to Theatre and/or ICU in a private hospital will be an added advantage.
• Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
• Excellent business writing & communication skills with exceptional telephone etiquette.
• Must have strong organisational awareness to anticipate the impact of actions on other groups.
• Time Management & good administration skills
• Effective conflict resolution skills and the ability to work under pressure.
• Must be a strong team player and results driven.
• Computer literacy (MS Office and Medical Administration system)

Duties and Responsibilities

• Ensuring successful & smooth Pre-Authorisation and case management process telephonically in a call centre environment, on email and online chat.
• Ensure adherence to Scheme Rules on all Hospital Authorisations and clinical updates.
• Ensure correct allocation of facilities for our Members.
• Effective handling of Internal/External Clinical Queries
• Communicate with members and service providers to address hospital utilisation matters.
• Assist with Health Risk Management Monitoring & Management of hospital re-admissions.
• Compile & submit detailed reports to the Scheme on costs and patient’s progress.