Healthcare Consultant for Pre-Authorisation Services

15 hours ago


Pretoria, Gauteng, South Africa Qetello Holdings Full time

**Job Overview:** Qetello Holdings seeks a skilled Clinical Pre-Authorisation Consultant to enhance its dynamic team. This role involves reviewing and evaluating pre-authorisation applications, ensuring seamless service delivery to healthcare providers and patients.

**Responsibilities:**

  • Review and process pre-authorisation applications with meticulous attention to detail.
  • Provide telephonic authorisations for hospital and radiology services through the call centre.
  • Capture and verify clinical details accurately, including ICD-10 and item codes.
  • Validate membership status and available benefits prior to granting authorisation.
  • Assess and process special pre-authorisation applications with discretion.
  • Apply relevant coding before approving benefits.
  • Analyse medical reports and doctors' motivations to ensure accurate decisions.
  • Communicate clearly with patients and service providers regarding scheme rules, benefits, and approvals.
  • Approve benefits in line with benefit options and protocols to mitigate scheme risks.
  • Maintain accurate records of all transactions and documentation.
  • Deliver exceptional customer service to members and providers.

**Requirements:

  • Education: Minimum Grade 12 certificate.
  • Nursing Qualification: Degree or diploma in nursing; registered with SANC.
  • Experience: At least two years in a private hospital or managed healthcare setting.

**Estimated Salary Range:** R500,000 - R700,000 per annum, commensurate with experience and qualifications.



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