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PRE-AUTHORISATION CONSULTANTS - 370134
Healthcare/ Pharmacies / Hospitals / Medical / Emergency Services
Wage / Salary:
R - Market Related - P/M (Per Month)
KEY RESPONSIBILITIES INCLUDE:
Ensuring successful & smooth Pre-Authorisation and case management process telephonically in a call centre environment, on email and online chat.
Ensure adherence to Scheme Rules on all Hospital Authorisations and clinical updates
Ensure correct allocation of facilities for our Members
Effective handling of Internal/External Clinical Queries Communicate with members and service providers to address hospital utilisation matters
Assist with Health Risk Management Monitoring & Management of hospital re-admissions
Compile & submit detailed reports to the Scheme on costs and patient’s progress
Desired Experience & Qualification
An exciting opportunity for an analytical and attention-to-detail Pre- Authorisation Consultant exists in the Hospital Benefit Management group. The successful candidate will utilise their Clinical, Pre-Authorisation & Case Management experience to build effective relationships with our members telephonically.
The position reports directly to the Service Manager: Managed HealthCare.
THE IDEAL CANDIDATE SHOULD HAVE:
Emergency Services qualification or any other Clinical/Medical qualification
Previous exposure in a Managed Healthcare Call Centre
10 years Pre-Auth experience if no clinical qualification
Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred.
Exposure to Theatre and/or ICU in a private hospital will be an added advantage.
Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
Excellent business writing & communication skills with exceptional telephone etiquette
Must have strong organisational awareness to anticipate the impact of actions on other groups.
Time Management & good administration skills
Effective conflict resolution skills and the ability to work under pressure.
Must be a strong team player and results driven.
Computer literacy (MS Office and Medical Administration system)
Package & Remuneration
SALARY NEGOTIABLE DEPENDING ON SKILLS, EXPERIENCE AND QUALIFICATION