Managed Care Professional

4 days ago


Pretoria, Gauteng, South Africa Ananzi Full time
Role Overview

Ananzi is seeking a Clinical Pre-Authorisation Consultant to join our dynamic team. As a Registered Nurse with at least two years of experience in Managed Healthcare or Private Hospital settings, you will be responsible for processing and evaluating pre-authorisation applications, ensuring compliance with scheme rules and delivering exceptional customer service.

Responsibilities:
  • Pre-Authorisation Applications: Evaluate and process pre-authorisation applications for hospital and radiology services.
  • Call Center Support: Handle telephonic authorisations, providing exceptional service to patients and service providers.
  • Clinical Data Management: Capture and verify clinical details, including ICD-10 and item codes.
  • Membership Benefits: Validate membership status and available benefits prior to granting authorisation.
  • Special Requests: Assess and process special pre-authorisation applications.
  • Clinical Analysis: Analyse medical reports and doctors' motivations.
  • Record Keeping and Compliance: Maintain accurate records of all transactions and documentation, ensuring compliance with scheme rules.


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