Consultant : Pre- Authorisation

Pps; Gauteng; On-site; ZAR 350 000 - 500 000; Full time

Job summary

A leading healthcare company in Gauteng is seeking a Pre-Authorisation Consultant to manage hospital authorisations and clinical updates. The ideal candidate should have a nursing qualification and substantial experience in managed healthcare, particularly in high-pressure environments. Strong communication skills and analytical abilities are essential. This permanent role offers the chance to make impactful decisions in patient care management.

Qualifications

• 10 years Pre-Auth experience if no clinical qualification.
• Previous exposure in a Managed Healthcare Call Centre.
• Sound knowledge of ICD10 & CPT4 Principles.

Responsibilities

• Ensuring successful Pre-Authorisation process telephonically.
• Ensure adherence to Scheme Rules on Hospital Authorisations.
• Compile & submit detailed reports to the Scheme.

Skills

Analytical skills

Attention to detail

Communication skills

Conflict resolution skills

Team player

Computer literacy (MS Office)

Education

Nursing qualification

Emergency Services qualification

Tools

Medical Administration system

Job description

Closing Date: Not specified

Reference Number: PPS

Job Type: Permanent

Job Title: Consultant : Pre-Authorisation

Business Unit: PPS Healthcare Administrators Department

Hospital Benefit Management

Location: Centurion, Gauteng, South Africa

Job Advert Summary

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.
• 10 years Pre-Auth experience if no clinical qualification.
• 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.

Preference will be given to Employment Equity candidates.

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The Company reserves the right to amend this stance, as and when required.