Pre - Authorisation

Key Requirements: Possess a nursing qualification and Emergency Services qualification or any other Clinical/Medical qualification 3-5 years of Pre-Auth experience is required Previous exposure to Renal Dialysis, Oncology, and/or Psychiatric environments would be highly preferred. Exposure to Theatre and/or ICU in a private hospital is an added advantage Sound knowledge of Coding Systems: and a deep understanding of the Medical Aid Industry, Rules & Regulations, ISO, and related legislation are necessary Excellent business writing and communication skills, along with exceptional telephone etiquette, are essential Must possess strong organisational awareness to anticipate the impact of actions on other groups Time management and good administration skills are required. Effective conflict resolution skills and the ability to work under pressure are necessary Must be a strong team player and results-driven. Computer literacy in MS Office and Medical Administration systems is required KEY RESPONSIBILITIES: Ensure successful and smooth Pre-Authorization and case management processes telephonically in a call centre environment, via email, and online chat Assist with Health Risk Management Monitoring and Management of hospital re-admissions Compile and submit detailed reports to the Scheme on costs and patient progress