Clinical Authorization Specialist
15 hours ago
We are seeking a skilled Clinical Authorization Specialist to join our team at the Palesa Mbali Group. This is an exciting opportunity for a qualified professional to utilize their expertise in clinical authorization and customer service to make a meaningful impact.
About the RoleThe Clinical Authorization Specialist will be responsible for authorizing hospital authorization requests, ensuring that requirements of clinical appropriateness, medical necessity, and clinical risk management are met. Key activities include:
- Applying coding principles, medical scheme rules, and benefits to authorize hospital authorization requests;
- Capturing accurate pre-authorisation data on the system;
- Educating and assisting members by providing relevant clinical information to access correct clinical benefits;
- Consulting member's healthcare professionals to make informed clinical decisions and manage financial risk;
- Correctly escalating complex clinical calls;
- Providing excellent customer service;
- Addressing all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in.
To be successful in this role, you will need to have a formal nursing qualification (SANC enrolled nurse) and at least 2-3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institution. You must also be computer literate and have a minimum of 3 years in the clinical space. Call centre experience and previous managed healthcare experience in a call centre environment are advantageous.
What We OfferIn return for your expertise and dedication, we offer a competitive salary of R450,000 per annum, commensurate with your experience, as well as opportunities for growth and development within the company.
Palesa Mbali Group is a highly respected organization with many top medical schemes under its umbrella. Our team is passionate about delivering exceptional customer service and making a positive impact on people's lives.
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