Pre Authorisations Consultant - Pretoria
iMedrecruit
Pre-authorisations Consultant, Pretoria Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant. Roles and Responsibilities (but not limited to): Attend to incoming calls from healthcare service providers and members/ beneficiaries. Verification of the eligibility of cover within available benefits as per scheme rules, clinical protocols and funding guidelines. Loading authorisations Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services and authorisation categories. Clinical Risk Management to reduce the risks associated with hospital and other authorised services. Establish the presence of any co-morbid conditions from the caller or beneficiary if caller is not able to assist. Refer to member management (case management) if co-morbid conditions are present for intervention and follow-up. Prepare and present cases for escalation to member management for discussion and resolution. Provide member care and education to patients Skills and Competencies Required: Minimum 2-3 years experience in a similar role within a managed healthcare or medical scheme environment Sound knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols Thorough, well-grounded clinical knowledge of the pre-authorisation of hospital admissions (including Length of Stay and Level of Care), in-rooms procedures and other healthcare services requiring pre-authorisation Excellent telephonic and written communication capability within a call centre environment (will be tested) Computer literate (will be tested) - MIP Application System experience will be advantageous Good organisational and task prioritisation skills Outstanding multitasking skills Proficiency in English written and verbal (an additional language will be advantageous) Ability to research and analyse information High degree of accuracy and attention to detail Compile and submit relevant reports in accordance with strict deadlines Results orientated Maintaining confidentiality of information Qualifications: Registered/ Enrolled Nurse Valid registration with SANC Hours: Shift work between 7h00 and 19h00 (Monday to Sunday). Required: ASAP Only candidates who meet all the minimum requirements stipulated in the advert, will be considered. If you do not hear from us within two weeks
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