Consultant:Pre- Authorisation

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.