Pre-Authorisation Consultant

Findojobs South Africa; Gauteng; On-site; ZAR 300,000 - 400,000; Full time

Job summary

A healthcare recruitment agency is looking for an Enrolled Nurse or Paramedic in Gauteng. The role involves authorizing hospital admissions, verifying benefits, and managing medical cases. Candidates should have 3-5 years of experience in pre-authorization and a solid understanding of healthcare regulations. This position offers an opportunity to work in a dynamic environment focused on service delivery.

Qualifications

• 3–5 years of experience in pre-authorization within managed healthcare.
• Knowledge of medical scheme regulations and billing procedures.

Responsibilities

• Authorize hospital admissions per scheme guidelines.
• Verify in-hospital benefits and funding.
• Manage surgical and medical cases within defined cost limits.
• Handle queries related to designated service providers.

Skills

Experience in pre-authorization

Knowledge of PMB conditions

Familiarity with ICD-10 codes

Understanding of hospital systems

Education

Enrolled Nurse / Paramedic

Job description

Requirements:

• Enrolled Nurse / Paramedic
• 3–5 years of experience in pre-authorization within managed healthcare.
• Knowledge of PMB conditions, clinical guidelines, ICD-10 codes, and hospital systems.
• Familiarity with medical scheme regulations and billing procedures.

Key Responsibilities:

• Authorize hospital admissions per scheme guidelines.
• Verify in-hospital benefits and funding.
• Manage surgical and medical cases within defined cost limits.
• Handle queries related to designated service providers, co-payments, and penalties.
• Refer complex and high-cost cases for further review.
• Maintain up-to-date knowledge of product changes and clinical guidelines.
• Achieve service delivery targets, including call center SLAs.