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 firstname.lastname@example.org with the Ref No in the subject line and if you do not hear from us within 2 weeks, please consider your application unsuccessful.