Medical Aid Pre-authorisation Officer
2 weeks ago
**Overview**:
We are looking for a **Medical Aid Pre-Authorisation Officer** for one of our clients. In this role, you will be responsible for securing pre-authorisations from medical aids, verifying patient benefits, and ensuring all services are cleared for cover before treatment takes place. You will play a key role in preventing claim rejections and ensuring smooth coordination between patients, providers, and medical aids.
**Key Responsibilities**:
- Obtain pre-authorisations from medical aids for scheduled procedures and treatments.
- Verify patients membership, benefits, and eligibility prior to appointments.
- Collect and submit the required clinical documentation for pre-authorisation requests.
- Track pending authorisations and follow up to ensure timely approvals.
- Communicate authorisation outcomes to doctors, billing, and scheduling staff.
- Record all authorisation and verification activities accurately in the practice management/EMR system.
- Handle pre-authorisation denials by submitting additional information or lodging appeals where needed.
- Stay up to date with medical aid rules, authorisation processes, and policy changes.
**Qualifications**:
- Minimum of 2 years experience in medical aid pre-authorisations and benefits verification.
- Solid understanding of South African medical aid schemes, rules, and clinical terminology.
- Proficiency in EMR/practice management and billing systems.
- Strong attention to detail and excellent organisational skills.
- Clear communication skills for liaising with medical aid representatives, doctors, and patients.
- Ability to work independently and manage multiple priorities.
- Familiarity with CentralReach is an advantage but not required.
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