Johannesburg: Pre-Authorisation Consultant

Requirements: Enrolled Nurse / Paramedic 35 years of experience in pre-authorization within managed healthcare. Knowledge of PMB conditions, clinical guidelines, ICD-10 codes, and hospital systems. Familiarity with medical scheme regulations and billing procedures. Key Responsibilities: Authorize hospital admissions per scheme guidelines. Verify in-hospital benefits and funding. Manage surgical and medical cases within defined cost limits. Handle queries related to designated service providers, co-payments, and penalties. Refer complex and high-cost cases for further review. Maintain up-to-date knowledge of product changes and clinical guidelines. Achieve service delivery targets, including call center SLAs.