Job Advert Summary
An 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.
Applications are invited for the above-mentioned position, to be filled as soon as possible.
Minimum Requirements
Nursing qualification.
Clinical Medical Associate
Paramedic
Emergency Services qualification or any other Clinical/Medical qualification
Previous exposure in a Managed Healthcare Call Centre
10 years Pre-Auth experience if no clinical qualification
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 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
Excellent 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 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)
Duties and Responsibilities
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 clinical updates.
Ensure correct allocation of facilities for our Members.
Effective handling of Internal/External Clinical Queries Communicate with members 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 patient's progress.
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