Together with our client in Pretoria, we are recruiting for a Medical Pre-Authorisation Consultant. The ideal candidate must have a completed qualification as an Enrolled Nurse and must be registered with SANC, with at least 2 years experience in Managed Healthcare.

Duties and responsibilities:

·        Receive applications for all services, which require pre-authorisation and attend to the request.

·        Capture clinical information and verify the information, including the applicable ICD-10 and item codes.

·        Validate and evaluate special pre-authorisation requests.

·        Prepare a summary of the members’ clinical history for the medical advisor.

·        Monitor the flow of documents between the pre-authorisation division and the medical advisor.

·        Approve benefits accurately according to the benefits per benefit options and strictly according to protocols.

·        Escalate identified risks about specific members or providers to seniors.

Skills and Qualifications:

·        Grade 12

·        Completed qualification as an Enrolled Nurse

·        Registered with SANC

·        2+ years of experience in Managed Healthcare

·        Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.

·        Computer literate in Ms Office.

·        Customer focus.

·        Must be able to work in a team and handle conflict situations.

·        Knowledge of the following:

o   Comprehensive knowledge of the Medical Scheme Act;

o   Sound knowledge of CPT-4, ICD-10 and RPL codes;

o   Extensive clinical knowledge;

o   Able to function independently with good decision-making skills; and

o   Exceptional work ethic.

Only candidates who meet all the requirements outlined in this advertisement will be considered. If you do not receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

To apply, please submit your CV and supporting documents to recruitment1@medicalresources.co.za with the subject line “REF: Pre-Auth.”