Clinical Authorisation Specialist
2 weeks ago
Palesa Mbali Group is a dynamic organisation seeking a highly skilled Clinical Authorisation Specialist to join our pre-authorisation call centre team.
Job SummaryWe are looking for a detail-oriented and customer-focused individual with a strong background in nursing and experience in clinical authorisation. The ideal candidate will possess excellent communication skills, be able to work under pressure, and have a keen eye for accuracy.
Key Responsibilities- Authorise hospital authorisation requests by applying coding principles, medical scheme rules and benefits, and managed care policies and processes.
- Capture accurate pre-authorisation data on the system
- Educate and assist members by providing relevant clinical information to access the correct clinical benefits
- Consult members' healthcare professionals to make informed clinical decisions and manage financial risk
- Correctly escalate complex clinical calls
- Provide exceptional customer service
- Address all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in
- Formal nursing qualification (SANC enrolled nurse) – required
- 2-3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institution
- Trauma/ER experience will be an advantage
- Previous managed healthcare experience in a call centre environment – advantageous
The successful candidate can expect a competitive salary of R250,000 - R350,000 per annum, depending on experience, as well as a range of benefits including medical aid, pension fund, and generous leave provisions.
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Healthcare Authorisation Specialist
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Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeJob Title: Healthcare Authorisation SpecialistThe Palesa Mbali Group is seeking a skilled Healthcare Authorisation Specialist to join our pre-authorisation call centre team. As a Healthcare Authorisation Specialist, you will be responsible for authorising hospital authorisation requests, ensuring that requirements of clinical appropriateness, medical...
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