Clinical Pre-Authorisation Consultant (Call Centre) - Medical Resources Group, Pretoria City Centre

  • Pretoria City Centre
  • Salary: R27 000.00 - R33 000.00 Per Month
  • Bonus: 13th Cheque
  • Job Type: Permanent
  • Posted by Medical Resources Group on Monday, January 6, 2020
  • Reference: Clinical Pre-Authorisation Consultant
  • Apply before Friday, March 6, 2020 - 10 Days left

Vacancy Details

Employer: Medical Resources Group

Together with our client we are recruiting for a Clinical Pre-Authorisation Consultant (Call Centre) in Pretoria.  The Candidate must be a registered nurse with SANC and have at least two years’ experience in the private healthcare sector.  Previous experience working at a Medical Aid Scheme would be an advantage.

Duties and Responsibilities

  • 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 aplicable 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

Job requirements

  • Matric
  • A completed degree/diploma as a registered nurse and must be   registered    with SANC.
  • Two year’s relevant experience in a private hospital.
  • Comprehensive knowledge of the Medical Schemes Act.
  • Sound knowledge of CPT-4 & ICD-10 codes RPL.  

Must possess the following skills:

  • Technical and professional knowledge and skills;
  • Managing work
  • Customer focus
  • Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken and written communication
  • Computer literate
  • Must work well with people and be able to handle conflict situations

 

Apply before Friday, March 6, 2020 - 10 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 Medical Resources Group

Qetello Holdings is a recruitment and human resource company based in Pretoria. Our diversified client base includes major corporations as well as small, emerging businesses. We provide recruitment and human resource advice and assistance in areas such as engineering and technical, information technology, manufacturing and distributions, pharmaceutical / healthcare, accounting and finance, general management, sales, marketing and general administration.

WHAT SETS US APART
We tailor our services for employers, keeping abreast of rapidly changing job market trends. We are dedicated professionals with strong corporate experience. As a small private firm, Qetello offer a critical advantage through:
"Hands-on" involvement by the managing partner Working with fewer clients by design Flexibility and resourcefulness. Having a database of qualified diversity sources Responsiveness to your recruiting, human resource and industrial relations needs

Recruitment service offered:
Pitfalls around employment policies are great and appointing the wrong applicant can be an expensive exercise. Qetello will assist you to acquire and appoint the right person into the right job.
Applicants are sourced from an in-house database, the internet, printed media, and from a national network. We recruit permanent staff on all levels, ranging from senior management to entry level. Qetello use recruitment techniques, which grant all applicants equal chances to apply for a specific position.

In terms of fees the range is between 8% and 15% of TAR (total annual remuneration package of the candidate) for placements. In order to determine where the rate should fall for each client, we need to assess the needs and range of services required.

Qetello candidates use only those tests which do not discriminate on the basis of culture, race or gender