Medical Pre-Authorisation Specialist

4 weeks ago


Pretoria, Gauteng, South Africa Qetello Holdings Full time
Job Title: Medical Pre-Authorisation Consultant

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.
Requirements:
  • 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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