Case Manager. Pre Authorization (Call Centre)

Company Medihelp
Reference # Cicelia Strauss
Published 09/01/2018
Location South Africa
Medihelp is currently looking for a Pre Authorization (Call Centre) Consultant. The candidates must be bilingual in Afrikaans and English. (read, write & speak)
Job Functions Administration,Call Centre,Client Services,Clinical
Industries Insurance
Receive applications for all services which require pre authorisation.
Handling of telephonic hospital authorisations on the Hospital 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 and service 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.
Grade 12.
A completed degree/diploma as a registered nurse and must be registered with SANC.
Two year’s relevant experience in a private hospital.
Comprehensive knowledge of the Medical Schemes Act.
Sound knowledge of CPT-4 & ICD-10 codes RPL.
Must possess the following skills:
- Technical and professional knowledge and skills;
- Managing work;
- Customer focus;
- Good communication skills in Afrikaans and English (read, write and speak);
- Computer literate.
Must work well with people, and be able to handle conflict situations
Job Closing Date 26/01/2018
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