Together with our client in Pretoria, we are recruiting for a Medical Pre-Authorisation Consultant. The ideal candidate must have a completed qualification as an Enrolled Nurse and must be registered with SANC, with at least 2 years experience in Managed Healthcare.

Duties and responsibilities:

Receive applications for all services, which require pre-authorisation and attend to the request.
Capture clinical information and verify the information, including the applicable ICD-10 and item codes.
Validate and evaluate special pre-authorisation requests.
Prepare a summary of the members’ clinical history for the medical advisor.
Monitor the flow of documents between the pre-authorisation division and the medical advisor.
Approve benefits accurately according to the benefits per benefit options and strictly according to protocols.
Escalate identified risks about specific members or providers to seniors.

Skills and Qualifications:

Grade 12
Completed qualification as an Enrolled Nurse
Registered with SANC
2+ years of experience in Managed Healthcare
Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.
Computer literate in Ms Office.
Customer focus.
Must be able to work in a team and handle conflict situations.
Knowledge of the following:
- Comprehensive knowledge of the Medical Scheme Act;
- Sound knowledge of CPT-4, ICD-10 and RPL codes;
- Extensive clinical knowledge;
- Able to function independently with good decision-making skills; and
- Exceptional work ethic.

Only candidates who meet all the requirements outlined in this advertisement will be considered. If you do not receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

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