An exciting opportunity for an analytical and attention-to-detail Pre- Authorisation Consultant exists in the Hospital Benefit Management group. The successful candidate will utilise their Clinical, Pre-Authorisation & Case Management experience to build effective relationships with our members telephonically.
Applications are invited for the above-mentioned position, to be filled as soon as possible.
, Requirements,
- Nursing qualification.
- Emergency Services qualification or any other Clinical/Medical qualification
- Previous exposure in a Managed Healthcare Call Centre
- 10 years Pre-Auth experience if no clinical qualification
- Previous exposure in Renal Dialysis, Oncology and/or Psychiatric environment would be most preferred.
- Exposure to Theatre and/or ICU in a private hospital will be an added advantage.
- Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation
- Excellent business writing & communication skills with exceptional telephone etiquette.
- Must have strong organisational awareness to anticipate the impact of actions on other groups.
- Time Management & good administration skills
- Effective conflict resolution skills and the ability to work under pressure.
- Must be a strong team player and results driven.
- Computer literacy (MS Office and Medical Administration system)
- Ensuring successful & smooth Pre-Authorisation and case management process telephonically in a call centre environment, on email and online chat.
- Ensure adherence to Scheme Rules on all Hospital Authorisations and clinical updates.
- Ensure correct allocation of facilities for our Members.
- Effective handling of Internal/External Clinical Queries Communicate with members and service providers to address hospital utilisation matters.
- Assist with Health Risk Management Monitoring & Management of hospital re-admissions.
- Compile & submit detailed reports to the Scheme on costs and patients progress.
You acknowledge that any information supplied to PPS is provided voluntarily and therefore constitutes unconditional, specific, and voluntary consent to the processing of such information by PPS. Your personal information will be processed for facilitating your application for employment with PPS as well as any statutory or regulatory compliance with which PPS must comply (where applicable) and for the legitimate interests of PPS and yourself, both during the recruitment process and thereafter. You may instruct PPS by written notice to cease the processing of your personal information at any time and, subject to the requirements of applicable South African law, request that PPS delete and/or de-identify such personal information.
As a responsible employer, PPS encourages you to vaccinate and take the recommended vaccine boosters. The Company reserves the right to amend this stance, as and when required.
