Hospital Pre-auth Service Agent

4 months ago


Eastern Cape, South Africa Health Solutions Full time

**Introduction**
- Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**
- To effectively contribute to the Pre-Authorisation Team, ensuring that key performance indicators and service level agreements are met and that all visits and in-room procedures are authorised according to protocol.**Requirements**:

- At least 4 years in the Pre-Authorisation field for a medical scheme is essential, alternatively a relevant health-related tertiary qualification including, but not limited to, BA Psychology, Biokinetics, Human Science etc.
- Excellent understanding of the medical scheme administration industry
- Working experience in a call centre environment is advantageous
- Exposure to medical claims and ICD-10 coding
- MS Office / 365 proficiency is essential

**Duties & Responsibilities**
- Pre-authorisation of all specialised radiology for all schemes, according to protocols.
- Pre-authorisation of all medical appliances and oxygen for all schemes.
- Ensure that all authorisations are completed within the specified time-frame.
- Escalate complicated cases to the Pre-Auth Team Leader for presentation at the clinical committee meeting.
- Ensure accurate and comprehensive notes or documents are recorded on the system.
- Check and action the pending list daily to ensure that SLAs are met.
- Enhance member experience by providing exceptional customer service.
- Assisting the Specialist Pre-Auth Team when necessary.

**Competencies**
- Telephone etiquette
- Excellent verbal and written communication skills
- Accountability
- Time management
- Attention to detail
- Relationship building
- Empathic nature
- Teamwork and cooperation



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