Clinical Pre Authorisation Consultant We are searching for an experienced Clinical Pre Authorisation Consultant. About the role: To ensure that all applications for pre authorisation justify clinical intervention and are finalized fairly, effectively and in full and to deliver exceptional client services. Essential functions of the job: Receive applications for all services which require pre authorisation Handling of telephonic authorisations, hospital and radiology on the pre-authorisation call centre. Capture clinical information and verify the information, including the applicable 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 andservice 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. Qualificationand Experience: Grade 12 with a completeddegree/diploma as a Registered nurse or a certificate as an Enrolled Nurse andmust be registered with SANC. Two years’ relevant experience. Skills and Knowledge: Good verbal and written English communicationskills as well as proficiency in understanding Afrikaans spoken and written communication. Computer literate in Ms Office. Customer focus. Managing own work. Comprehensive knowledge of the Medical Schemes Act. Must work well with people and be able to handleconflict situations. Must be willing to multiskilling in other sectionswithin managed care. Sound knowledge of CPT-4&ICD-10 codes RPL. Selected candidates on theshortlist will be expected to undergo a full selection process. Selection andrecruitment are executed in accordance with Medihelp’s recruitment&selection and employment equity policies. Medihelp is under no obligation tomake an appointment where justifiable. Enquiries can be directed to CiceliaStrauss at cstrauss@medihelp.co.za Closing date: January 2024 POPIADisclaimer: By sending your CV to the above emailaddress you agree to: Provide voluntary consent to the processing of your personal information required to access or register your profile in order to facilitate online communication through this platform. The use of your personal information only for purposes for which it is collected or agreed with you (e.g. conduct criminal, credit, reference and other related reference checks). The exercising of your rights provided for by the Protection of Personal Information Act 4 of 2013 (POPI Act). Acknowledge that Medihelp will store the record of your personal information to ensure its privacy and confidentiality in a secure and safe manner according to strict security safeguards. #J-18808-Ljbffr