Medical Pre-Authorisation Specialist
4 weeks ago
Qetello Holdings is seeking a skilled Medical Pre-Authorisation Specialist to join our team in Pretoria. The ideal candidate will have a completed qualification as an Enrolled Nurse and be registered with SANC, with at least 2 years of experience in Managed Healthcare.
The successful candidate will be responsible for:
- Receiving and attending to applications for services requiring pre-authorisation.
- Capturing and verifying clinical information, including ICD-10 and item codes.
- Validating and evaluating special pre-authorisation requests.
- Preparing a summary of members' clinical history for the medical advisor.
- Monitoring the flow of documents between the pre-authorisation division and the medical advisor.
- Approving benefits accurately according to protocols.
- Escalating identified risks to seniors.
Key qualifications include:
- Grade 12
- Completed qualification as an Enrolled Nurse
- Registered with SANC
- 2+ years of experience in Managed Healthcare
- Good verbal and written English communication skills, as well as proficiency in understanding Afrikaans spoken and written communication.
- Computer literacy in Ms Office.
- Customer focus.
- Ability to work in a team and handle conflict situations.
- Comprehensive knowledge of the Medical Scheme Act.
- Sound knowledge of CPT-4, ICD-10 and RPL codes.
- Extensive clinical knowledge.
- Exceptional work ethic.
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