Medical Pre-Authorisation Consultant - Enrolled Nurse Market Related
Job details
Medical Pre-Authorisation ConsultantTogether 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 & ResponsibilitiesReceive 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.Desired Experience & QualificationGrade 12Completed qualification as an Enrolled NurseRegistered with SANC2+ years of experience in Managed HealthcareGood verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication.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; andExceptional 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.Package & RemunerationMarket related
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