Job title: Pre-Authorisation Consultant - Managed Healthcare
Job type: Permanent
Emp type: Full-time
Industry: Medical Aid / Medical Schemes
Location: City of Tshwane Metropolitan Municipality, South Africa
Job published: 20/05/2020
Job ID: 32373
Contact name: Linda Pakshong
Contact email: linda@medicalplaces.com

Job Description

Our client in the Managed Healthcare industry is urgently seeking an experienced Pre-Authorisation Consultant to join the Group.  The ideal candidate will need to meet the following minimum criteria:

 

EE Role open to Male and Female applicants

 

Minimum Requirements:

  • Grade 12
  • A Registered Nursing qualification (Non Negotiable)
  • Must have experience as a Pre-Authorisation Consultant at a Healthcare Administrator (Non Negotiable)
  • Intensive Nursing Science and Operating Theatre Techniques qualification will be an added advantage
  • Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred
  • Exposure to Theatre and/or ICU in a private hospital would 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 (Non negotiable)
  • Previous exposure in a Managed Healthcare Call Center (Non Negotiable)
  • Excellent business writing & communication skills with exceptional telephone etiquette
  • Must have a strong organisational awareness in order 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)

 

Key Responsibilities:

  • Ensuring successful and smooth Pre-Authorisation and case management process telephonically in a call center environment, on email and online chat.
  • Ensure adherence to Scheme Rules on all Hospital Authorisations ad clinical updates
  • Ensure correct allocation of facilities for our Members
  • Effective handling of Internal/External Clinical Queries, Communicate with members and service providers in order 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
  • Position reports to Service Manager: Managed Healthcare
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