Pre-authorisation Consultant

7 months ago

Pretoria, South Africa HRInsync Full time

**Pre-Authorisation Consultant**

**Introduction**

One of the largest private Medical Aid companies in SA. They have been providing healthcare to the lives of South Africans for over 56 years. And are striving to be #1 in SA.

**Purpose**

Delivering cost-effective managed healthcare services to accomplish member satisfaction.

**Duties & Responsibilities**
- Client Relations, to assist the client by approving appropriate funding
- Effective Customer Service delivery, to deliver an effective call centre service in order to achieve member satisfaction
- Telephone Etiquette, answering telephone calls in a way that achieves member satisfaction
- Verifying prosthesis limits, to contain costs for both members and fund
- On-going training and development, to update knowledge and skills in order to deliver a cost-effective and professional service
- The actual benefit expenditure per beneficiary per month for hospitalization should be less than the budget benefit expenditure
- Pre-authorization should be granted within the option benefits, Scheme and clinical protocols
- Delivering a cost-effective Managed Healthcare service within the average length of hospital stay per beneficiary
- Thorough, well-grounded clinical knowledge of Pre-Authorization of hospital admissions and Case Management of hospital cases in order to take cost-effective and appropriate decisions in evaluating treatment, LOS and LOC
- Knowledge of the current coding structures in the South African Health Care environment i.e. ICD10’s, CPT4, NRPL, and PMB conditions, protocols and Scheme rules

**Skills & Qualifications**

Qualification - Essential
- Grade 12
- Enrolled Nurse

Qualification - Preferred
- B Cur degree / Diploma in Nursing
- Registered Nurse

Experience - Essential
- Minimum 5 years’ experience as a nursing practitioner
- Minimum 1-year experience gained in the medical funding industry

Ability to commute/relocate:

- Pretoria, Gauteng: Reliably commute or planning to relocate before starting work (required)

**Education**:

- Diploma (required)

**Experience**:

- nursing: 5 years (required)
- medical aid schemes: 1 year (required)

  • Pre Authorisations Consultant

    6 months ago

    Pretoria, South Africa iMedrecruit Full time

    About the job Pre Authorisations Consultant **Pre-authorisations Consultant, Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/ beneficiaries. - Verification...

  • Clinical Pre-Authorisation Consultant

    1 month ago

    Pretoria, South Africa Jobted ZA C2 Full time

    Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply! Key...

  • Pre Authorisations Consutlant

    6 months ago

    Pretoria, South Africa iMedrecruit Full time

    **Pre-authorisations Consultant, Pretoria** Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant. **Roles and Responsibilities (but not limited to)**: - Attend to incoming calls from healthcare service providers and members/ beneficiaries. - Verification of the eligibility of cover within available...

  • Clinical Pre-Authorisation Consultant

    1 month ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply! Key...

  • Clinical Pre-Authorisation Consultant

    1 month ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is seeking a Clinical Pre-Authorisation Consultant to join their dynamic team. If you're a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse or Enrolled Nurse, with at least two years of experience in Managed Healthcare or Private Hospital settings, we encourage you to apply!Key...

  • Healthcare Consultant for Pre-Authorisation Services

    2 weeks ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    **Job Overview:** Qetello Holdings seeks a skilled Clinical Pre-Authorisation Consultant to enhance its dynamic team. This role involves reviewing and evaluating pre-authorisation applications, ensuring seamless service delivery to healthcare providers and patients.**Responsibilities:**Review and process pre-authorisation applications with meticulous...

  • Pre-authorisation Consultant

    7 months ago

    Pretoria, South Africa Recruitforce Group Full time

    Position: Coordinator: Member Care (Pre-authorisations) Reporting to: Contact Centre Operational Manager Location: On-site at the Head Office, Pretoria _**You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday)**_ **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC **Skills and Competencies Required**: -...

  • Pre-authorisation Consultant

    7 months ago

    Pretoria, South Africa RecruitForce Full time

    Position**:Coordinator: Member Care** **(Pre-Reporting to: Contact Centre Operational Manager)** Location: On-site at the Head Office, Pretoria - **Please Note: You will be required to work shifts between 7h00 and 19h00 (Monday to Sunday)**_ **Qualifications**: - Registered/ Enrolled Nurse - Valid registration with SANC **Skills and Competencies...

  • Medical Pre-Authorisation Consultant

    6 months ago

    Pretoria, South Africa Qetello Holdings Full time

    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...

  • Junior Pre-authorisation Consultant

    4 months ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team in Pretoria. **What will you be doing in this role?** - You will work in a Call Centre, answering calls on a daily basis and you will provide Members and/or Service Providers with Authorisation, for clinical procedures in hospital. (Training will...

  • Pre-authorisation Consultant

    6 months ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid is seeking a Pre-Auth Consultant to join their Call Centre team in Pretoria. A reputable Medical Aid Scheme, based in Pretoria, is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team. **Duties**: - Delivering cost-effective managed healthcare services to accomplish member satisfaction. - Assisting...

  • Healthcare Authorisation Consultant

    3 weeks ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    About the Role:We are seeking a highly skilled Healthcare Authorisation Consultant to join our team in Pretoria. The ideal candidate must hold a completed qualification as an Enrolled Nurse and be registered with SANC, boasting at least 2 years of experience in Managed Healthcare.The successful candidate will be responsible for reviewing and processing...

  • Pre-authorisation Consultant

    7 months ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid Scheme, based in Pretoria, is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team. **Duties**: - Delivering cost-effective managed healthcare services to accomplish member satisfaction. - Assisting the Client by approving appropriate funding. - Delivering an effective Call Centre service in order to...

  • Pre-authorisation Consultant

    7 months ago

    Pretoria, South Africa HRInsync Full time

    **Company** One of the largest private Medical Aid companies in SA. They have been established for 20 years and are striving to be #1 in SA. **Purpose** Delivering cost-effective managed healthcare services to accomplish member satisfaction. **Responsibilities**: - Client Relations, To assist the client by approving appropriate funding - To deliver an...

  • Pre-authorisation Consultant

    1 week ago

    Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid based in Pretoria is seeking a strong Registered Nurse who is keen to start their career in the Managed Healthcare industry. **Requirements**: - SANC Registered Nurse - ICU / Theatre trained (Advantage) - ER/Trauma experience - A minimum of 5 years as a Nursing Practitioner - Excellent clinical knowledge - Excellent written and...

  • SAP Authorisation Consultant

    2 days ago

    Pretoria, South Africa Mediro ICT Full time

    Role build Second line support Do basic trouble shooting Experience in MS office products (strong Excel skills required) Applications operations support for Authorisations Providing 1st level support to users, adhering to documented processes Providing 2nd level support to processes where documented Monitoring logs for user queries SAP Fiori(would be...

  • Junior Pre-Auth Consultant: HBM

    4 months ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is looking for a Junior Pre-Auth Consultant (HBM) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner, and at...

  • Junior Pre-Auth Consultant: HBM

    4 months ago

    Pretoria, South Africa Qetello Holdings Full time

    Our client is looking for a Junior Pre-Auth Consultant (HBM) to deliver cost-effective managed healthcare services primarily via email correspondence, ensuring member satisfaction. The ideal candidate will have a Grade 12 qualification, Auxiliary Nursing certification, active SANC membership, a minimum of 5 years' experience as a nursing practitioner, and at...

  • Clinical Consultant: Member Care

    2 days ago

    Pretoria, South Africa Recruitforce Group Full time

    Our client, a managed care organisation in Pretoria are currently looking for a Member Care Clinical Consultant (Pre-authorisations). - **You will be required to work shifts between 07h00 and 19h00 (Monday to Sunday).**_ **Reporting to**:Operations Manager: Contact Centre **Location**:Head Office - Lynnwood, Pretoria (On-site) **Salary**:Market related...

  • Clinical Pre Authorisation Consultant

    2 weeks ago

    Pretoria, South Africa Stafflink Recruitment Solutions Full time

    **Functions**: **Min Requirements**: Grade 12. A completed degree/diploma as a Registered nurse and must be registered with SANC. Two years relevant experience in a private hospital. Comprehensive knowledge of the Medical Schemes Act. Sound knowledge of CPT-4 & ICD-10 codes RPL. Must possess the following skills: - **Technical and professional knowledge...