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Pre-authorisation Consultant

4 weeks 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 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.
- On-going training and development: Updating knowledge and skills in order to deliver a cost-effective and professional service.
- Confirming the actual benefit expenditure per beneficiary, per month for hospitalization should be less than the budget benefit expenditure.
- Ensuring that pre-authorization 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 12
- 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 / week-end shifts / standby etc.

**Education**:

- Diploma (required)

**Experience**:

- working as a Nurse in a Private hospital: 5 years (required)

License/Certification:

- SANC (required)