Pretoria: Clinical Pre-Authorisation Consultant posted by Qetello
Posted on 2025-05-21 00:00:00
| Employer | Qetello |
|---|---|
| Category | Other Medical |
| Location | Gauteng / 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, 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:
Interested candidates who meet the requirements are invited to submit their CV and supporting documents to *****@*****.co.za with the subject line REF: Pre-Auth
Please note: If you have not received feedback within two weeks of your application, consider your application unsuccessful.
Click Go Apply to apply online!
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