Vacancies
Job Seeker DashboardTogether 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.”