Healthcare Consultant for Pre-Authorisation Services
15 hours ago
**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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