SUMMARY:
A well-established company located in Johannesburg North is looking for a Pre-Authorisation Consultant to join their team!
POSITION INFO:
Requirements:
- Enrolled Nurse / Paramedic
- 3–5 years of experience in pre-authorization within managed healthcare.
- Knowledge of PMB conditions, clinical guidelines, ICD-10 codes, and hospital systems.
- Familiarity with medical scheme regulations and billing procedures.
Key Responsibilities:- Authorize hospital admissions per scheme guidelines.
- Verify in-hospital benefits and funding.
- Manage surgical and medical cases within defined cost limits.
- Handle queries related to designated service providers, co-payments, and penalties.
- Refer complex and high-cost cases for further review.
- Maintain up-to-date knowledge of product changes and clinical guidelines.
- Achieve service delivery targets, including call center SLAs.
