Recruite
A well-established company located in Johannesburg North is seeking a Pre-Authorisation Consultant to join their team.
Requirements
- Enrolled Nurse / Paramedic
- 3–5 years of experience in pre-authorization within managed healthcare
- Knowledge of PMB conditions, clinical guidelines, ICD-10 codes, and hospital systems
- Familiarity with medical scheme regulations and billing procedures
Key Responsibilities
- Authorize hospital admissions per scheme guidelines
- Verify in-hospital benefits and funding
- Manage surgical and medical cases within defined cost limits
- Handle queries related to designated service providers, co-payments, and penalties
- Refer complex and high-cost cases for further review
- Maintain up-to-date knowledge of product changes and clinical guidelines
- Achieve service delivery targets, including call center SLAs
Desired Skills
- Pre-Authorization Consultant
- Managed Healthcare
- Hospital Admission Authorization
- Medical Scheme Benefits