Pretoria: Clinical Pre-Authorisation Consultant

Date	2024-12-05
Job Title	Clinical Pre-Authorisation Consultant
Employer	More Information
Salary
Category	Healthcare Nursing
Location	Tshwane / Pretoria

Job Summary

Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you`re a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply Key

Responsibilities:

• Application Review: Process and evaluate pre-authorisation applications. • Telephonic Authorisations: Handle pre-authorisations for hospital and radiology services through the call center. • Data Entry & Verification: Accurately capture and verify clinical details, including ICD-10 and item codes. • Membership Validation: Confirm membership status and available benefits prior to granting authorisation. • Special Requests: Assess and process special pre-authorisation applications. • Coding Accuracy: Apply appropriate coding before approving benefits. • Clinical Interpretation: Analyse medical reports and doctors` motivations. • Information Sharing: Provide patients and service providers with clear, relevant information on scheme rules, benefits, and approvals. • Benefits Management: Approve benefits in line with benefit options and protocols to mitigate scheme risks. • Record Keeping: Maintain accurate records of all transactions and documentation. • Service Excellence: Deliver outstanding service to members and providers. • Continuous Learning: Stay updated on scheme rules, benefit options, legislation, protocols, and system changes.

Requirements:

• Education: Minimum Grade 12 certificate. • Nursing Qualification: Degree or diploma in nursing; registered with SANC. • Experience: At least two years in a private hospital or managed healthcare setting. Knowledge: • Medical Schemes Act. • Proficiency in CPT-4 and ICD-10 coding, with RPL knowledge. Skills: • Strong technical and professional capabilities. • Exceptional time and work management. • Outstanding customer focus. • Fluent in English (spoken and written) with understanding of Afrikaans. • Proficient computer literacy. • Interpersonal Abilities: • Effective team collaboration. • Conflict resolution skills. • Flexibility: Willingness to cross-train in other managed care sections. How to Apply:

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Clinical Pre-Authorisation Consultant position available in Tshwane, Pretoria. This job position was posted by . The job has been posted on 2024-12-05 in the Healthcare Nursing category

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