Pre Authorisations Consutlant - Pretoria, South Africa - iMedrecruit

iMedrecruit

Verified Company

Pretoria, South Africa

1 week ago

Posted by:

Thabo Mthembu

beBee Recruiter

Description

Pre-authorisations Consultant, Pretoria
Our client, focusing on a risk and clinical assessment offering, is requiring a Pre-Authorisations Consultant.

Roles and Responsibilities (but not limited to):

Attend to incoming calls from healthcare service providers and members/ beneficiaries.
Verification of the eligibility of cover within available benefits as per scheme rules, clinical protocols and funding guidelines.
Loading authorisations
Strict adherence to benefits, scheme rules, clinical protocols and funding guidelines across all services and authorisation categories.
Clinical Risk Management to reduce the risks associated with hospital and other authorised services.
Establish the presence of any comorbid conditions from the caller or beneficiary if caller is not able to assist.
Refer to member management (case management) if comorbid conditions are present for intervention and followup.
Prepare and present cases for escalation to member management for discussion and resolution.
Provide member care and education to patients

Skills and Competencies Required:

Minimum 23 years experience in a similar role within a managed healthcare or medical scheme environment
Sound knowledge of the South African Healthcare industry and prevailing legislation, current coding structures i.e. ICD10s, CPT4, NRPL, PMB conditions and clinical protocols
Thorough, wellgrounded clinical knowledge of the preauthorisation of hospital admissions (including Length of Stay and Level of Care), inrooms procedures and other healthcare services requiring preauthorisation
Excellent telephonic and written communication capability within a call centre environment (will be tested)
Computer literate (will be tested)
MIP Application System experience will be advantageous
Good organisational and task prioritisation skills
Outstanding multitasking skills
Proficiency in English written and verbal (an additional language will be advantageous)
Ability to research and analyse information
High degree of accuracy and attention to detail
Compile and submit relevant reports in accordance with strict deadlines
Results orientated
Maintaining confidentiality of information