Medical Pre-Authorisation Specialist
4 weeks ago
Qetello 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 process applications for pre-authorisation services, ensuring timely and accurate processing.
- Capture and verify clinical information, including ICD-10 and item codes, to support pre-authorisation decisions.
- Evaluate and validate special pre-authorisation requests, ensuring compliance with protocols and regulations.
- Prepare and provide clinical summaries for medical advisors, facilitating informed decision-making.
- Monitor and manage the flow of documents between the pre-authorisation division and medical advisors.
- Approve benefits accurately, adhering to benefit options and protocols.
- Identify and escalate potential risks associated with specific members or providers to senior management.
- Grade 12 qualification
- Completed qualification as an Enrolled Nurse
- Registration with SANC
- At least 2 years of experience in Managed Healthcare
- Excellent verbal and written communication skills in English, with proficiency in Afrikaans
- Proficiency in Microsoft Office
- Customer-focused approach
- Ability to work effectively in a team and handle conflict situations
- Knowledge of:
- Medical Scheme Act
- CPT-4, ICD-10, and RPL codes
- Extensive clinical knowledge
- Decision-making skills
- Exceptional work ethic
Only candidates meeting all the requirements outlined in this advertisement will be considered. If you do not receive feedback within 2 weeks, please consider your application unsuccessful.
To apply, please submit your CV and supporting documents to recruitment1@qetello.co.za with the subject line 'REF: Pre-Auth EN.'
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