Medical Call Centre/ Medical Aid / Hospital / Pre-Authorisation Case Manager - Creative Sourcing, Pretoria

  • Pretoria
  • Salary: R25 000.00 - R35 000.00 Per Month
  • Job Type: Permanent
  • Posted by Creative Sourcing on Thursday, January 23, 2020
  • Reference: 1598338
  • Apply before Monday, March 23, 2020 - 30 Days left

Vacancy Details

Employer: Creative Sourcing

We have an opportunity available for a Medical Aid / Hospital / Pre-Authorisation Case Manager based in Pretoria.

Duties will include:

  • Receive applications for all services which require pre authorisation.
  • Handling of telephonic authorisations, hospital, radiology and specialist referrals on the pre-authorisation call centre.
  • Capture clinical information and verify the information, including the applicable ICD-10 and item codes.
  • Confirm membership status & available benefits on the system before authorisation can be granted.
  • Validate and evaluate special pre-authorisation requests.
  • Ensure that the correct codes are used before benefits are approved.
  • Clinical interpretation and analysis of medical reports and/or doctor’s motivation.
  • Provide correct applicable information in respect of scheme rules, benefits & approvals in respect of all services requiring to patients and service providers.
  • Approve benefits accurately according to the benefits per benefit option and strictly according to the protocols to reduce the Scheme’s risk in respect of benefits.
  • Accurate and complete capturing of all relevant information as well as approved documents on the appropriate operational systems.
  • Deliver a high quality service to the members and service providers.
  • Keep abreast of amendments to scheme rules, benefit options, legislation, protocols, processes and systems.

Candidate Requirements

  • Matric
  • Nursing Degree/Diploma completed
  • Registered nurse with SANC
  • 2+ years’ relevant experience in a private hospital
  • Knowledge of the Medical Schemes Act
  • Knowledge of CPT-4 & ICD-10 codes RPL
  • Fluent in Afrikaans and English
Apply before Monday, March 23, 2020 - 30 Days left Companies may expire jobs at their own discretion. If you have not received a response within two weeks, your application was most likely unsuccessful.
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About Creative Sourcing

We are a dedicated recruitment company that will endeavour to understand all aspects of your company culture, as well as the specific details of your constantly evolving recruitment needs.
It is this commitment, along with a history of sourcing exceptional personnel, that leads to our successful and long-term client relationships.