Medical Pre Authorisation Consultant (enrolled Nurse)
Pretoria, Gauteng, South Africa
Job Description
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.
- 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:
- Comprehensive knowledge of the Medical Scheme Act;
- Sound knowledge of CPT-4, ICD-10 and RPL codes;
- Extensive clinical knowledge;
- Able to function independently with good decision-making skills; and
- Exceptional work ethic.
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Job Detail
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Job IdJD1340812
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IndustryNot mentioned
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Total Positions1
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Job Type:Full Time
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Salary:R30000 - 35000 per month
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Employment StatusPermanent
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Job LocationPretoria, Gauteng, South Africa
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EducationNot mentioned