Pre-authorisation Consultant

5 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

    5 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...

  • Pre Authorisations Consutlant

    5 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...

  • Pre-authorisation Consultant

    5 months ago

    Pretoria, South Africa care force Full time

    **Description**: 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...

  • Pre-authorisation Consultant

    5 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**: -...

  • Medical Pre-Authorisation Specialist

    1 month ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Medical Pre-Authorisation ConsultantQetello Holdings is seeking a highly skilled Medical Pre-Authorisation Consultant to join our team in Pretoria. As a key member of our team, you will be responsible for ensuring that all medical services requiring pre-authorisation are processed efficiently and effectively.Key Responsibilities:Receive and...

  • Medical Pre-Authorisation Specialist

    2 months ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    {"Job Title": "Medical Pre-Authorisation Consultant", "Job Summary": "We are seeking a skilled Medical Pre-Authorisation Consultant to join our team at Qetello Holdings. The ideal candidate will have a strong background in managed healthcare and excellent communication skills.", "Responsibilities": "Key Responsibilities:Receive and process pre-authorisation...

  • Pre-authorisation Consultant

    5 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 Specialist

    2 months ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Medical Pre-Authorisation ConsultantQetello Holdings is seeking a highly skilled Medical Pre-Authorisation Consultant to join our team in Pretoria. As a key member of our team, you will be responsible for ensuring seamless pre-authorisation processes for our clients.Key Responsibilities:Receive and process pre-authorisation requests for various...

  • Medical Pre-Authorisation Specialist

    4 weeks ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Medical Pre-Authorisation ConsultantQetello Holdings is seeking a highly skilled Medical Pre-Authorisation Consultant to join our team in Pretoria. The ideal candidate will have a completed qualification as an Enrolled Nurse and be registered with SANC, with at least 2 years of experience in Managed Healthcare.Key Responsibilities:Receive and...

  • Medical Pre-Authorisation Consultant

    4 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...

  • Medical Pre-Authorisation Consultant

    4 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

    2 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

    5 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...

  • Pre-authorisation Consultant

    6 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...

  • Junior Pre-Authorization Consultant

    2 months ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Junior Pre-Authorization ConsultantWe are seeking a highly skilled and motivated Junior Pre-Authorization Consultant to join our team at Qetello Holdings. As a key member of our healthcare services team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills...

  • Junior Pre-Authorization Consultant

    1 month ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Junior Pre-Authorization ConsultantWe are seeking a highly skilled and motivated Junior Pre-Authorization Consultant to join our team. As a key member of our healthcare services team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills to facilitate the...

  • Junior Pre-Authorization Consultant

    2 months ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Junior Pre-Authorization ConsultantWe are seeking a highly skilled and motivated Junior Pre-Authorization Consultant to join our team at Qetello Holdings. As a key member of our healthcare services team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills...

  • Pre-authorisation Consultant

    6 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...

  • Junior Pre-Auth Consultant: HBM

    1 month ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Junior Pre-Auth Consultant: HBMWe are seeking a highly skilled and motivated Junior Pre-Auth Consultant to join our team at Qetello Holdings. As a key member of our healthcare team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills to facilitate the...

  • Medical Consultant Coordinator

    2 weeks ago

    Pretoria, Gauteng, South Africa Qetello Holdings Full time

    Job Title: Junior Pre-Auth Consultant: HBMWe are seeking a skilled Junior Pre-Auth Consultant to join our team at Qetello Holdings. As a Junior Pre-Auth Consultant, you will play a crucial role in delivering cost-effective managed healthcare services to our members.Knowledge and Skills: The ideal candidate will have a Grade 12 qualification, Auxiliary...