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    Medical Pre-Authorisation Consultant - Pretoria, South Africa - Qetello Holdings

    Qetello Holdings
    Qetello Holdings Pretoria, South Africa

    4 hours ago

    Default job background
    Full time
    Description

    Together with our client in Pretoria, we are recruiting for a Medical Pre-Authorisation Consultant. The ideal candidate must have a completed qualification as an Enrolled Nurse and must be registered with SANC, with at least 2 years experience in Managed Healthcare.

    Duties and responsibilities:

    • Receive applications for all services, which require pre-authorisation and attend to the request.
    • Capture clinical information and verify the information, including the applicable ICD-10 and item codes.
    • Validate and evaluate special pre-authorisation requests.
    • Prepare a summary of the members' clinical history for the medical advisor.
    • Monitor the flow of documents between the pre-authorisation division and the medical advisor.
    • Approve benefits accurately according to the benefits per benefit options and strictly according to protocols.
    • Escalate identified risks about specific members or providers to seniors.

    Skills and Qualifications:

    • 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 literate in Ms Office.
    • Customer focus.
    • Must be able to work in a team and handle conflict situations.
    • Knowledge of the following:
      • Comprehensive knowledge of the Medical Scheme Act;
      • Sound knowledge of CPT-4, ICD-10 and RPL codes;
      • Extensive clinical knowledge;
      • Able to function independently with good decision-making skills; and
      • Exceptional work ethic.

    Only candidates who meet all the requirements outlined in this advertisement will be considered. If you do not receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

    To apply, please submit your CV and supporting documents to with the subject line "REF: Pre-Auth."

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