Consultant: Non-clinical Pre Authorisations

4 weeks ago


Centurion, South Africa PPS Recruitment Full time

Job Advert Summary
An exciting opportunity for an analytical and attention-to-detail Pre
**The position reports directly to the Service Manager**: Hospital Benefit Management.
Minimum Requirements
Previous exposure in a Managed Healthcare Call Centre
Pre-Auth experience
Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred.
**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)

**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.



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