Description:
Join our team in Pretoria as we collaborate with our valued client to seek a Clinical Pre-Authorisation Consultant (Registered Nurse). We are looking for an ideal candidate who holds a registered nurse qualification, backed by a degree or diploma and is registered with the South African Nursing Council (SANC). Additionally, the candidate should bring a minimum of two years of experience in Managed Healthcare or Private Hospital settings to the table.
Responsibilities:
Application Review: You'll be responsible for receiving and processing applications that necessitate pre-authorization. Telephonic Authorizations: Handle pre-authorizations for hospital and radiology services via our call center. Data Entry and Verification: Accurately capture and validate clinical information, including ICD-10 and item codes. Membership Confirmation: Verify membership status and available benefits before granting authorization. Special Requests: Evaluate and process special pre-authorization requests. Code Accuracy: Ensure the correct coding is applied before approving benefits. Clinical Analysis: Provide clinical interpretation and analysis of medical reports and doctor's motivations. Information Dissemination: Offer clear and applicable information regarding scheme rules, benefits, and approvals to patients and service providers. Benefits Approval: Accurately approve benefits based on benefit options and protocols to minimize the scheme's risk. Data Management: Thoroughly and accurately record all relevant information and approved documents in our operational systems. High-Quality Service: Deliver exceptional service to members and service providers. Stay Informed: Keep up-to-date with changes in scheme rules, benefit options, legislation, protocols, processes, and systems.
Skills and Qualifications:
Education: A minimum of a Grade 12 certificate. Nursing Qualification: Must hold a registered nurse degree/diploma and be registered with SANC. Relevant Experience: Two years of experience in a private hospital setting. Legislative Knowledge: Comprehensive understanding of the Medical Schemes Act. Coding Proficiency: Sound knowledge of CPT-4 and ICD-10 codes, with RPL proficiency. Skills Set: Possess technical and professional knowledge and skills, strong work management abilities, customer focus, excellent verbal and written English communication skills, and proficiency in understanding spoken and written Afrikaa...
Additional Info:
2 to 4 years
Salary: RR30000 to R35000
Job Reference #: 193066510
04 Oct 2023;
from:
gumtree.co.za