Medical Authorisation Specialist

5 days ago


Pretoria, Gauteng, South Africa Ananzi Full time
Job Description

Ananzi seeks a Clinical Pre-Authorisation Consultant to join their dynamic team. As a healthcare professional registered with the South African Nursing Council (SANC) as a Registered Nurse, you will have at least two years of experience in Managed Healthcare or Private Hospital settings.

Key Responsibilities:
  1. Application Review and Evaluation: Process and assess pre-authorisation applications for hospital and radiology services, ensuring accurate and timely decision-making.
  2. Telephonic Authorisations: Handle pre-authorisations through the call center, providing exceptional service to patients and service providers.
  3. Data Entry and Verification: Accurately capture and verify clinical details, including ICD-10 and item codes, to maintain high-quality records.
  4. Membership Validation: Confirm membership status and available benefits prior to granting authorisation, ensuring compliance with scheme rules.
  5. Special Requests and Coding Accuracy: Assess and process special pre-authorisation applications, applying appropriate coding before approving benefits.
  6. Clinical Interpretation and Information Sharing: Analyse medical reports and doctors' motivations, providing clear, relevant information on scheme rules, benefits, and approvals to patients and service providers.
  7. Benefits Management and Record Keeping: Approve benefits in line with benefit options and protocols to mitigate scheme risks, maintaining accurate records of all transactions and documentation.
  8. Service Excellence and Continuous Learning: Deliver outstanding service to members and providers, staying updated on scheme rules, benefit options, legislation, protocols, and system changes.


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