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Consultant Pre-Authorisation

Vacancy Details

Reference No.

MS4-44124

Synopsis

An exciting opportunity for an analytical and attention-to-detail Pre- Authorisation Consultant exists in the organisation. The successful candidate will utilise their Clinical, Pre-Authorisation and Case Management experience to build effective relationships with our members telephonically.

Description

  • Ensure successful and smooth Pre-Authorisation and case management process telephonically in a call centre environment, on email and online chat
  • Ensure adherence to Scheme Rules on all Hospital Authorisations and 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 and Management of hospital re-admissions
  • Compile and submit detailed reports to the Scheme on costs and patients progress

Requirements

Qualification

  • A minimum of Grade 12
  • A Registered Nursing qualification

 

Requirements and Skills

  • 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 will be an added advantage
  • Sound knowledge of the Coding Systems: ICD10 and CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules and Regulations, ISO and other related legislation
  • Previous exposure in an organisation Call Centre
  • Excellent business writing and communication skills with exceptional telephone etiquette
  • Must have strong organisational awareness in order to anticipate the impact of actions on other groups
  • Time management and 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)

 

Kindly note, if you have not heard from us within two weeks of your application please consider it unsuccessful

Position Type

Permanent

Work Level

Skilled

Salary

Market Related

Industry

Pharmaceutical And Medical/Healthcare

Salary Type

Monthly

Package

Cost To Company

Affirmative Action

Yes

Geographic Location

Gauteng - Centurion