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Healthcare Pre-Approval Specialist

2 weeks ago

Pretoria, Gauteng, South Africa Qetello Holdings Full time
Job Responsibilities
  • Manage and process applications for services requiring pre-authorisation, ensuring timely and accurate approvals.
  • Capture and verify clinical information, including ICD-10 and item codes, to support informed decision-making.
  • Evaluate complex pre-authorisation requests, applying comprehensive knowledge of medical schemes and protocols.
  • Prepare detailed summaries of members' clinical histories for medical advisors, facilitating informed decisions.
  • Maintain effective communication with stakeholders, including seniors and providers, to ensure smooth workflow and resolve potential conflicts.
Key Requirements
  • Grade 12 qualification
  • Completed qualification as an Enrolled Nurse
  • Registered with SANC
  • At least 2 years of experience in Managed Healthcare
  • Excellent verbal and written English communication skills, with proficiency in Afrikaans
  • Able to work independently, with good decision-making skills and a strong work ethic