Pre-Authorisation Consultants HBM

About the position

Pre-Authorisation Consultants HBM
Ref: PreHBM/MVG
Salary: Market related
Located: Pretoria

Our client, in Managed Care, seeks to employ an Enrolled Nurse for the accurate issuing of appropriate Pre-Authorisations that meets the requirements of clinical appropriateness. The role is performed in a contact centre.

Key requirements:

• Enrolled Nurse with SANC.
• Minimum of 5 years experience as a nursing practitioner (Private Hospital: Medical/ Surgical/ ICU)
• 1 year experience gained in the medical funding industry (essential).
• Medical Scheme-related experience in Hospital Benefits Management required.

Key responsibilities:

• Support clients by authorizing suitable funding in line with healthcare requirements.
• Provide high-quality call centre support to ensure a positive experience for members.
• Mitigate risks linked to hospital admissions and authorized medical treatments.
• Respond to phone calls in a courteous and efficient manner to promote member satisfaction.
• Confirm prosthesis limits to manage expenses effectively for both the member and the fund.
• Enhance knowledge and competencies regularly to maintain a cost-efficient and professional level of service.
• Ensure hospitalization costs per beneficiary per month remain within budgeted limits, and that pre-authorizations align with benefit structures, scheme policies, and clinical standards.
• Provide responsive and efficient support through the call centre to maintain high levels of member satisfaction.
• Implement managed healthcare solutions that are both economical and focused on delivering quality care.
• Evaluating treatment, LOS and LOC.
• Knowledge of current coding systems (ICD10's, CPT4, NRLP, and HBM conditions).

To apply, email copies of your supporting documents together with your CV to [Email Address Removed] or call us on [Phone Number Removed];.

Supporting documents required:

• Copy of SANC receipt
• Copy of ID
• Copy of latest pay slip
• Copy of qualification(s) and Matric

Desired Skills:

• Medical Scheme

Desired Work Experience:

• 2 to 5 years Admin Clerk

Desired Qualification Level:

• Diploma