Medical Pre-Authorisation Specialist
2 months ago
Qetello Holdings is seeking a highly skilled Medical Pre-Authorisation Consultant to join our team in Pretoria. As a key member of our team, you will be responsible for ensuring seamless pre-authorisation processes for our clients.
Key Responsibilities:- Receive and process pre-authorisation requests for various services, ensuring timely and accurate decision-making.
- Capture and verify clinical information, including ICD-10 and item codes, to support informed decision-making.
- Evaluate and validate special pre-authorisation requests, ensuring compliance with protocols and regulations.
- Prepare comprehensive summaries of members' clinical histories for medical advisors, facilitating informed decision-making.
- Monitor and manage the flow of documents between the pre-authorisation division and medical advisors, ensuring efficient communication.
- Approve benefits accurately, adhering to benefit options and protocols, to ensure member satisfaction.
- Identify and escalate potential risks related to members or providers, ensuring proactive issue resolution.
- Grade 12 qualification
- Completed qualification as an Enrolled Nurse
- Registration with SANC
- At least 2 years of experience in Managed Healthcare
- Excellent verbal and written communication skills in English, with proficiency in Afrikaans
- Proficiency in Microsoft Office
- Strong customer focus and ability to work effectively in a team
- Knowledge of the Medical Scheme Act, CPT-4, ICD-10, and RPL codes
- Extensive clinical knowledge and ability to function independently
Only candidates meeting all the specified requirements will be considered. If you do not receive feedback within 2 weeks, please consider your application unsuccessful.
To apply, please submit your CV and supporting documents to the relevant contact, referencing the job title and reference number.
-
Medical Pre-Authorisation Specialist
2 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Medical Pre-Authorisation SpecialistWe are seeking a highly skilled Medical Pre-Authorisation Specialist to join our team at Qetello Holdings. As a key member of our team, you will be responsible for managing pre-authorisation requests and ensuring seamless communication between our medical advisors and clients.Key Responsibilities:Receive and...
-
Medical Pre-Authorisation Specialist
2 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeAt Qetello Holdings, we are seeking a Medical Pre-Authorisation Specialist to join our team. The ideal candidate will have a completed qualification as an Enrolled Nurse and be registered with SANC, with at least 2 years experience in Managed Healthcare.Key Responsibilities:Receive applications for pre-authorisation services and process requests.Capture and...
-
Medical Pre-Authorisation Specialist
3 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeQetello 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...
-
Medical Pre-Authorisation Specialist
1 month ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Medical Pre-Authorisation ConsultantQetello Holdings is seeking a highly skilled Medical Pre-Authorisation Consultant to join our team in Pretoria. As a key member of our team, you will be responsible for ensuring that all medical services requiring pre-authorisation are processed efficiently and effectively.Key Responsibilities:Receive and...
-
Medical Pre-Authorisation Specialist
2 months ago
Pretoria, Gauteng, South Africa Qetello Holdings Full time{"Job Title": "Medical Pre-Authorisation Consultant", "Job Summary": "We are seeking a skilled Medical Pre-Authorisation Consultant to join our team at Qetello Holdings. The ideal candidate will have a strong background in managed healthcare and excellent communication skills.", "Responsibilities": "Key Responsibilities:Receive and process pre-authorisation...
-
Medical Pre-Authorisation Specialist
4 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Medical Pre-Authorisation ConsultantQetello Holdings is seeking a highly skilled Medical Pre-Authorisation Consultant 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.Key Responsibilities:Receive and...
-
Junior Pre-Auth Healthcare Specialist
2 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Junior Pre-Auth Healthcare Specialist Job Summary:We are seeking a talented and experienced Junior Pre-Auth Healthcare Specialist to join our team at Qetello Holdings. The ideal candidate will have a strong background in nursing and will be responsible for delivering cost-effective managed healthcare services primarily via email...
-
Medical Consultant Coordinator
2 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Junior Pre-Auth Consultant: HBMWe are seeking a skilled Junior Pre-Auth Consultant to join our team at Qetello Holdings. As a Junior Pre-Auth Consultant, you will play a crucial role in delivering cost-effective managed healthcare services to our members.Knowledge and Skills: The ideal candidate will have a Grade 12 qualification, Auxiliary...
-
Medical Escort Specialist
4 weeks ago
Pretoria, Gauteng, South Africa IOM Full timeJob Title: Medical Escort SpecialistAt IOM, we are seeking a highly skilled and experienced Medical Escort Specialist to join our team. As a Medical Escort Specialist, you will be responsible for providing medical escort services to beneficiaries during all phases of their journey, from pre-departure to handover upon arrival.Key Responsibilities:Provide...
-
Junior Pre-Authorization Consultant
1 month ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Junior Pre-Authorization ConsultantWe are seeking a highly skilled and motivated Junior Pre-Authorization Consultant to join our team. As a key member of our healthcare services team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills to facilitate the...
-
Medical Escort Specialist
2 months ago
Pretoria, Gauteng, South Africa IOM Full timeJob DescriptionJob Title: Medical Escort SpecialistJob Summary:We are seeking a highly skilled Medical Escort Specialist to join our team at IOM. As a Medical Escort Specialist, you will be responsible for providing medical escort services to beneficiaries during all phases of their journey, from pre-departure to handover upon arrival.Key...
-
Junior Pre-Authorization Consultant
2 months ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Junior Pre-Authorization ConsultantWe are seeking a highly skilled and motivated Junior Pre-Authorization Consultant to join our team at Qetello Holdings. As a key member of our healthcare services team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills...
-
Junior Pre-Authorization Consultant
2 months ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Junior Pre-Authorization ConsultantWe are seeking a highly skilled and motivated Junior Pre-Authorization Consultant to join our team at Qetello Holdings. As a key member of our healthcare services team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills...
-
Medical Consultant: HBM
3 weeks ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeAt Qetello Holdings, we are seeking a highly skilled Junior Pre-Auth Consultant: HBM to join our team. This role is ideal for a motivated individual with a passion for delivering cost-effective managed healthcare services.Key Responsibilities:Employ negotiation skills to facilitate the pre-authorisation process.Maintain accurate record-keeping and...
-
Medical Office Coordinator
6 hours ago
Pretoria, Gauteng, South Africa Mirna Butler Recruitment Full timeWe are seeking a highly skilled Medical Receptionist to join our esteemed specialist medical practice in Pretoria-East.The ideal candidate will possess excellent interpersonal skills, be computer literate, and have experience in Practice Management.This is a fantastic opportunity for individuals who enjoy working in a dynamic healthcare environment.Key...
-
Healthcare Pre-Authorization Specialist
2 months ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeQetello Holdings is seeking a qualified Medical Pre-Authorization Consultant to join our dynamic team. The successful candidate will possess a completed qualification as an Enrolled Nurse and must be registered with SANC, alongside a minimum of 2 years of experience in the Managed Healthcare sector.Key Responsibilities:Process applications for services...
-
Junior Pre-Auth Consultant: HBM
1 month ago
Pretoria, Gauteng, South Africa Qetello Holdings Full timeJob Title: Junior Pre-Auth Consultant: HBMWe are seeking a highly skilled and motivated Junior Pre-Auth Consultant to join our team at Qetello Holdings. As a key member of our healthcare team, you will be responsible for delivering cost-effective managed healthcare services to our members.Key Responsibilities:Employ negotiation skills to facilitate the...
-
Clinical Quality Assurance Specialist
4 weeks ago
Pretoria, Gauteng, South Africa H2R Africa Full timeAt H2R Africa, we are seeking a highly skilled Clinical Quality Assurance Specialist to join our dynamic team in Pretoria. The successful candidate will be responsible for ensuring that our team maintains high standards of clinical quality and compliance.Key Responsibilities:Conduct regular audits of pre-authorisation cases to ensure compliance with clinical...
-
Medical Escort Specialist
2 months ago
Pretoria, Gauteng, South Africa IOM Full time{"title": "Medical Escort Specialist", "description": "Job SummaryWe are seeking a highly skilled Medical Escort Specialist to join our team at IOM. As a Medical Escort Specialist, you will be responsible for providing medical escort services to beneficiaries during all phases of their journey under IOM's care.Key ResponsibilitiesProvide medical escort...
-
Medical Escort Specialist
1 month ago
Pretoria, Gauteng, South Africa IOM Full timeJob Title: Medical Escort SpecialistWe are seeking a highly skilled Medical Escort Specialist to join our team at IOM. As a Medical Escort Specialist, you will be responsible for providing medical escort services to beneficiaries during all phases of their journey under IOM's care.Key Responsibilities:Provide medical escort services to beneficiaries during...