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Healthcare Pre-Authorisation Specialist

2 weeks ago

Pretoria, Gauteng, South Africa Medical Resources Group Full time

**Job Overview:**

We are seeking a skilled Clinical Pre-Authorisation Consultant to join our dynamic team at the Medical Resources Group. This role involves reviewing and evaluating pre-authorisation applications for hospital and radiology services.

**Key Responsibilities:**

  • Application Review: Process and evaluate pre-authorisation applications to ensure accurate and efficient service delivery.
  • Telephonic Authorisations: Handle pre-authorisations through the call center, providing clear and relevant information to patients and service providers.
  • Data Entry & Verification: Accurately capture and verify clinical details, including ICD-10 and item codes, to maintain accurate records of all transactions and documentation.
  • Membership Validation: Confirm membership status and available benefits prior to granting authorisation.

**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.