Medical Aid Pre-Authorisation Officer

18 hours ago

Johannesburg, Gauteng, South Africa Affinity International Full time R250 000 - R500 000 per year


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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