Medical Pre-Authorisation Consultant

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 recruitment1@qetello.co.za with the subject line “REF: Pre-Auth.”