Consultant:pre- Authorisation

2 weeks ago

Centurion, Gauteng, South Africa PPS Recruitment Full time

Job Advert Summary:

An exciting opportunity for an analytical and attention-to-detail Pre

Applications are invited for the above-mentioned position, to be filled as soon as possible.

Minimum Requirements:

  • Nursing qualification.
  • 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)

Duties and Responsibilities:

  • 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 readmissions.
  • Compile & submit detailed reports to the Scheme on costs and patient's progress.
  • As a responsible employer, PPS encourages you to vaccinate and take the recommended vaccine boosters. The Company reserves the right to amend this stance, as and when required_.

  • Consultant:pre- Authorisation

    4 weeks ago

    Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: An exciting opportunity for an analytical and attention-to-detail Pre Applications are invited for the above-mentioned position, to be filled as soon as possible. **Minimum Requirements**: - Nursing qualification. - Emergency Services qualification or any other Clinical/Medical qualification - Previous exposure in a Managed...