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Pre-authorisation Consultant
2 weeks ago
A reputable Medical Aid Scheme, based in Pretoria, is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team.
Duties:
- Delivering costeffective managed healthcare services to accomplish member satisfaction.
- Assisting the Client by approving appropriate funding.
- Delivering an effective Call Centre service in order to achieve member satisfaction.
- Reducing the risk associated with hospital and authorized cases
- Answering telephone calls in a way that achieves member satisfaction.
- Verifying prosthesis limits by containing costs for both members and fund.
- Ongoing training and development: Updating knowledge and skills in order to deliver a costeffective and professional service.
- Confirming the actual benefit expenditure per beneficiary, per month for hospitalization should be less than the budget benefit expenditure.
- Ensuring that preauthorization should be granted within the option benefits, Scheme and clinical protocols.
- Delivering an effective Call Centre service in order to achieve member satisfaction.
Requirements:
- Grade 1
- SANC registered
- 5 years experience as an Enrolled Nursing Practitioner
combined with a minimum of 1 year experience gained in the Medical Aid Scheme industry
OR: - A Registered Nurse (SANC) with a minimum 5 years experience in Theatre/ICU/Surgical/Trauma/ wards, within a Private Hospital setting
- Excellent communication skills / telephone etiquette
- The ability to work in a Call Centre environment, constantly answering calls and providing authorisation for hospitalization or clinical procedures
Job Types:
Full-time, Permanent
Salary:
R1,00 - R2,00 per month
Application Question(s):
- For which Medical Aid Schemes have you previously or currently work?
- What is your monthly salary expectation? (Before deductions) Bearing in mind this role does not offer any allowances / weekend shifts / standby etc.
Education:
- Diploma (required)
Experience:
- working as a Nurse in a Private hospital: 5 years (required)
License/Certification:
- SANC (required)
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