Hospital Pre-Auth Service Agent

Hospital Pre-Auth Service Agent, based in Port Elizabeth. Our client delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. *ROLES AND RESPONSIBILITIES:* * To effectively contribute to the Pre-Authorisation team, ensuring that the KPI's and SLAs are met and that all visits and in-room procedures are authorised according to protocol. * Pre-authorisation of all in-hospital procedures for applicable Schemes, according to CRM protocols, telephonically and via email. * Pre-authorisation of all specialised radiology for all Schemes, according to CRM protocols. * Pre-authorisation of all medical appliances and oxygen for all Schemes. * All authorisations need to be completed within 48 hours of receipt. * Answering the telephone within 15 seconds (maintain KPIs). * Escalate complicated cases to CRM Pre Auth Team Leader for presentation at the clinical committee meeting. * Ensure that accurate and comprehensive notes are recorded on the system. * Document savings. * Check pending list daily and must not exceed 14 days. * Rotational filing of audit reports. * Running of daily reports and distribution to the applicable Case Managers. * Enhance member experience by providing exceptional customer service. * Assisting the Specialist Pre Auth-Team when necessary.   *BEHAVIOURAL REQUIREMENTS:* * Telephone etiquette & communication –; verbal and written * Accountability * Time management * Attention to detail * Relationship building and interpersonal understanding * Customer orientation and results orientation * Empathy * Teamwork and cooperation * Business administration Skills * Language proficiency: able to communicate in at least 1 African language preferable *EXPERIENCE AND QUALIFICATIONS:* * Relevant *health-related tertiary qualification* including, but not limited to, BA Psychology, Bio-Kinetics, Human Science, Diploma in Nursing (Enrolled Nurse) etc*. - Essential* * Excellent understanding of the Medical Scheme Administration industry * MS Office Suite (Word, Excel, Outlook etc.) * Relevant experience in a call centre environment - Advantageous * Exposure to claims and ICD-10 coding - Advantageous *REF Code: PRE* Location: Port Elizabeth Profile: Healthcare Career Level: 3+ Employment: Permanent, full-time E.E. / Non-EE: African only Working Hours: 08:00 AM to 17:00 PM Salary: Commensurate with experience *EXPERIENCE AND QUALIFICATIONS:* * Relevant *health-related tertiary qualification* including, but not limited to, BA Psychology, Bio-Kinetics, Human Science, Diploma in Nursing (Enrolled Nurse) etc*. - Essential* * Excellent understanding of the Medical Scheme Administration industry * MS Office Suite (Word, Excel, Outlook etc.) * Relevant experience in a call centre environment - Advantageous * Exposure to claims and ICD-10 coding - Advantageous