| Date | 2024-06-08 |
|---|---|
| Job Title | Prospective Reviewer (Pre-Authorisation Call Centre) |
| Employer | Palesa Mbali Group More Information |
| Salary | 0 |
| Category | It Computer |
| Location |
Gauteng / Johannesburg |
Job Summary
The Prospective Reviewer role within the pre-authorisation call centre, is responsible for authorising hospital authorisation requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met.
Key Activities:
- Authorising hospital authorization requests by applying coding principles, medical scheme rules and benefits, and managed care policies and processes.
- Capture accurate pre-authorisation data on the system
- Educate and assist member by providing relevant clinical information to access the correct clinical benefits
- Consult member`s health care professional to make informed clinical decisions and manage financial risk
- Correctly escalate complex clinical call
- Provide excellent customer service
- Address all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in
Education and Experience:
- Formal nursing qualification (SANC enrolled nurse) required
- 2 3 years experience in a general medical or general surgical ward, with at least 1 year at a private institution
- Trauma/ER experience will be an advantage.
- Previous Managed Healthcare experience in a call centre environment advantageous
Prospective Reviewer (Pre-Authorisation Call Centre) position available in Gauteng, Johannesburg. This job position was posted by Palesa Mbali Group. The job has been posted as a premium ad on 2024-06-08 at 13:15:40 in the It Computer category
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Prospective Reviewer (Pre-Authorisation Call Centre)