Title PRE-AUTHORISATION CONSULTANT
Categories Gauteng
Salary R348k pa Negotiable
Location Centurion
Job Information

Ref 6672.

We have an exciting opportunity for an analytical and attention-to-detail Pre-Authorisation Consultant at a Managed Healthcare Group based in Centurion.  The successful candidate will utilise their Clinical, Pre-Authorisation and Case Management experience to build effective relationships with the company’s members telephonically.

The position reports directly to the Service Manager – Managed Healthcare.

The ideal candidate should have:

  • A minimum of Grade 12.
  • A Registered Nursing qualification – Intensive Nursing Science and Operating Theatre Techniques qualifications will be an added advantage.
  • Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environments will be preferred.
  • Sound knowledge of the Coding Systems – ICD10 and CPT4 principles, as well as sound knowledge of the Medical Aid industry, Rules and Regulations, ISO and other related legislation.
  • Excellent business writing and communication skills, with exceptional telephone etiquette.
  • Strong organisational awareness in order to anticipate the impact of actions on other groups.
  • Time management and good admin 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 include:

  • Ensuring successful and smooth Pre-Authorisation and Case Management process telephonically in a Call Centre environment, on email and online chat.
  • Strict adherence to Scheme Rules on all Hospital Authorisations and clinical updates.
  • Ensuring correct allocation of facilities for the company’s members.
  • Effectively handling of Internal/External Clinical Queries.
  • Communicating with members and service providers in order to address Hospital utilisation matters.
  • Assisting with Health Risk Management monitoring and management of Hospital re-admissions.
  • Compiling and submitting details reports to the Scheme on costs and patient progress.

Preference will be given to AIC candidates.

Please email your CV to cvgauteng@etalyons.co.za with the Ref No in the subject line and if you do not hear from us within 2 weeks, please consider your application unsuccessful.

 

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