Pre -Authorisation Consultant

Pre -Authorisation ConsultantVacancy DetailsReference No.PRSynopsisAn exciting opportunity for an analytical and attention-to-detail Pre- Authorisation Consultant exists in the Hospital Benefit Management group. The successful candidate will utilise their Clinical, Pre-Authorisation & Case Management experience to build effective relationships with our members telephonically.DescriptionKEY RESPONSIBILITIES INCLUDE:Ensuring successful & 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 clinicalEnsure correct allocation of facilities for their Members.Effective handling of Internal/External Clinical Queries Communicate withmembers and service providers 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 patients progressRequirementsQUALIFICATIONS AND EXPERIENCENursing qualification.Emergency Services qualification or any other Clinical/Medical qualificationPrevious exposure in a Managed Healthcare Call Centre10 years Pre-Auth experience if no clinical qualificationPrevious 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 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislationExcellent business writing & communication skills with exceptional telephone etiquette.Must have strong organisational awareness to anticipate the impact of actions on other groups.Time Management & good administration skillsEffective 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 that all positions will be filled in accordance with the Companys Employment Equity plan. We also encourage people with disabilities to apply.
Johannesburg, GT, ZA