Requirements: Registered with SANC Clinical qualification Registered Nurse / Professional Nurse or qualified qualified Paramedic Minimum of 3 years in a clinical role Experience in Theatre and or ICU; Medical aid coding; and case management processes Application of clinical codes and finalisation thereof (Level 3 coding)
and Control; Clinical Facilitation Skills: Auditing and accreditation processes Clinical risk management
we collaborate with our valued client to seek a Clinical Pre-Authorisation Consultant (Registered Nurse) Verification: Accurately capture and validate clinical information, including ICD-10 and item codes. applied before approving benefits. Clinical Analysis: Provide clinical interpretation and analysis of medical
pre-authorisation and attend to the request. Capture clinical information and verify the information, including pre-authorisation requests. Prepare a summary of the members' clinical history for the medical advisor. Monitor the flow knowledge of CPT-4, ICD-10 and RPL codes; Extensive clinical knowledge; Able to function independently with
Pre-Authorisations that meets the requirements of clinical appropriateness. The role is performed in a contact
trends by reading all literature and relevant clinical papers as provided/recommended by line manager
trends by reading all literature and relevant clinical papers as provided/recommended by line manager
experience in interacting with Specialists by applying clinical knowledge or experience to medical aid related
experience in interacting with Specialists by applying clinical knowledge or experience to medical aid related
diaries within required timelines) • Handling of clinical enquiries and discussions with patients and health according to SLA requirements Professional and clinical knowledge required in checking the capturing of