Job Description

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Job Advert Summary

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 Pre-Authorisation & Case Management experience to build effective relationships with our members telephonically.



The position reports directly to the Service Manager: Hospital Benefit Management.

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Minimum Requirements

Previous exposure in a Managed Healthcare Call Centre Pre-Auth experience Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred. 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)
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Duties and Responsibilities

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.

Preference will be given to Employment Equity candidates




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