Pre-Authorisation Consultant

We are excited to present a dynamic opportunity with our client in the Medical Scheme Industry for an Enrolled Nurse / Paramedic Pre-Authorisation Consultant.

This is your chance to join a dedicated team, ensuring seamless patient care and efficient hospital admissions. You will be responsible for loading new authorisations and providing basic telephonic case management.

You'll ensure that cases are monitored from admission to discharge, with a complete understanding of the patient's progress.

If you have a passion for healthcare and Case Management and you're ready to contribute to a dynamic healthcare environment and take on a challenging and rewarding role, this is your chance.

Apply now and be part of a team that makes a real impact on patient care!

Key Performance Areas:

1. Pre-authorise member hospital admissions according to scheme benefits and departmental guidelines.
2. Confirm in-hospital and related funding benefits accurately.
3. Telephonic Case Management of surgical cases up to and medical cases up to excluding joint replacements.

Job Key Responsibilities:

1. Pre-authorise hospital admissions based on scheme protocols and funding guidelines.
2. Capture authorisation details accurately to ensure correct funding.
3. Review codes and apply savings in the daily pre-authorisation report.
4. Address DSP queries related to penalties and co-payments promptly.
5. Initiate non-declaration processes when necessary.
6. Provide outstanding service to stakeholders by resolving queries via phone and other communication channels.
7. Prepare and escalate high-cost cases or those requiring specialised case management.
8. Stay updated on product changes and benefits to offer top-notch service.

Desired Skills:

1. Rules and scheme product knowledge
2. Audit reason and decisions
3. iMed and Cubed systems

Employer & Job Benefits:

Medical Aid