Consultant:pre- Authorisation

**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 re-admissions.
- 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_.