Senior Officer Pre Authorisation at Medihelp Jobs at Medihelp in Pretoria, Gauteng

Medihelp company opens jobs for Senior Officer Pre Authorisation at Medihelp positions in the Gauteng region. The type of work we provide is Full-time.

The criteria for the employees we need are having Other, Information Technology, & Management skills with Mid-Senior level experience, as well as employees who are honest, disciplined and responsible.

The estimated salary offered by this company is quite competitive around R 4 500 - R 15 000 (per month). However, the salary can go up or down depending on the company that decides it.

The Headhunters company itself is engaged in Hospitals and Health Care, of course if you are interested in applying for this company, you can register immediately.

Job Information

Job Description

About The Role

• To ensure that applications for pre authorisation justify clinical intervention and are finalized fairly, effectively and in full.

Essential Functions Of The Job

• Receive applications for all services, which require pre authorisation and attend to the request.
• Capture clinical information and verify the information, including the applicable ICD-10 and items codes.
• Validate and evaluate special pre authorisation requests.
• Prepare a summary of the members’ clinical history for the medical advisor.
• Monitor the flow of documents between the pre authorisation division and the medical advisor.
• Approve benefits accurately according to the benefits per benefit options and strictly according to protocols.
• Escalate identified risks about specific members or providers to senior.

Qualification And Experience

• Grade 12, with a completed qualification as an Enrolled Nurse and must be registered with SANC, with at least 2 years’ experience in Managed Healthcare.

Skills And Knowledge

• Good verbal and written English communication skills as well as proficiency in understanding Afrikaans spoken andwritten communication.
• Computer literate in Ms Office.
• Customer focus.
• Must be able to work in a team and handle conflict situations.
• Knowledge of the following:-
• Comprehensive knowledge of the Medical Scheme Act;
• Sound knowledge of CPT-4, ICD-10 and RPL codes;
• Extensive clinical knowledge;
• Able to function independently with good decision making skills; and
• Exceptional work ethic.

Desired Skills

• Good communication skills
• Good computer skills
• Customer Focus

Desired Work Experience

• 2 to 5 years

Desired Qualification Level & Accreditations

• Certificate
• South African Nursing Council

About The Employer

Being self-administered, we take ownership and responsibility for every aspect of the membership of 202 099 lives who have entrusted their health and wellness to us. Our administration is thus not outsourced, but enabled by an in-house, bespoke IT system, providing a clear and undivided focus on our core business.

Since the Scheme is owned by its members and not by shareholders, it guarantees that the interest of the collective membership will always supersede that of the individual. Members are represented by a membernominated and appointed Board of Trustees to which the Scheme’s management reports.

Employer & Job Benefits

• pension fund
• medical aid
• 13th Cheque

Benefit

• Bonus for overtime
• Gain experience
• Comfortable work environment