Pre-authorisation Consultant - Pretoria, South Africa - Medpharm Recruitment

Medpharm Recruitment
Medpharm Recruitment
Verified Company
Pretoria, South Africa

1 week ago

Thabo Mthembu

Posted by:

Thabo Mthembu

beBee Recruiter
Description
A reputable Medical Aid is seeking a Pre-Auth Consultant to join their Call Centre team in Pretoria.


A reputable Medical Aid Scheme, based in Pretoria, is seeking a Pre-Authorisation Consultant to join their Hospital Benefit Management team.


Duties:


  • Delivering costeffective managed healthcare services to accomplish member satisfaction.
  • Assisting the Client by approving appropriate funding.
  • Delivering an effective Call Centre service in order to achieve member satisfaction.
  • Reducing the risk associated with hospital and authorized cases
  • Answering telephone calls in a way that achieves member satisfaction.
  • Verifying prosthesis limits by containing costs for both members and fund.
  • Ongoing training and development: Updating knowledge and skills in order to deliver a costeffective and professional service.
  • Confirming the actual benefit expenditure per beneficiary, per month for hospitalization should be less than the budget benefit expenditure.
  • Ensuring that preauthorization should be granted within the option benefits, Scheme and clinical protocols.
  • Delivering an effective Call Centre service in order to achieve member satisfaction.

Requirements:


  • Grade 1
  • SANC registered
  • 5 years experience as an Enrolled Nursing Practitioner
    combined with a minimum of 1 year experience gained in the Medical Aid Scheme industry
    OR:
  • A Registered Nurse (SANC) with a minimum 5 years experience in Theatre/ICU/Surgical/Trauma/ wards, within a Private Hospital setting
  • Excellent communication skills / telephone etiquette
  • The ability to work in a Call Centre environment, constantly answering calls and providing authorisation for hospitalization or clinical procedures

Job Types:
Full-time, Permanent


Salary:
R1,00 - R2,00 per month


Application Question(s):

  • For which Medical Aid Schemes have you previously or currently work?
  • What is your monthly salary expectation? (Before deductions) Bearing in mind this role does not offer any allowances / weekend shifts / standby etc.

Education:


  • Diploma (required)

Experience:

- working as a Nurse in a Private hospital: 5 years (required)


License/Certification:

  • SANC (required)
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