Clinical Pre- Authorization Agent

Location: Centurion, Gauteng

Position Purpose: To ensure the accurate issuing of appropriate pre-authorisations that meets the requirements of clinical appropriateness, medical necessity and clinical risk management

Experience: A minimum of 2-3 years' experience in a Managed Healthcare will be advanteagous

Qualifications: A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered / Enrolled Nurse). (MANDATORY REQUIREMENT)

• Advice on best practice health risk solutions to relevant parties
• Application of clinical intervention principles
• Advise on best practice health risk solutions to
• Excellent understanding of Call Centre technology
• Application of financial and risk assessment methodology
• Authorise hospital authorisation requests by applying coding principles, scheme rules and benefits, and managed care policies and processes
• Capture accurate pre-authorisation data on the system
• Correctly elevate complex clinical call
• Meet delivery objectives through working with other team members within and linked to the department / project
• Resolve operational performance variations and problems and elevate unresolved issues to higher levels
• Ensure delivery targets/objectives are met and operate in a supportive manner to achieve

Knowledge

• Knowledge and application of dispensing of meds, surgical material & procedures
• Application of financial and risk assessment methodology
• Knowledge of scheme rules and contractual negotiations
• Application of clinical intervention principles
• Advise on best practice health risk solutions to relevant parties
• Knowledge and application of relevant legislation
• Knowledge and application of processes and procedure

Skills

• MS office
• Negotiation and Telephone Skills
• Communication Skills
• Business Writing Skills
• Relevant systems knowledge and application
• Ability to negotiate and influence
• Problem Solving
• Numerical Ability
• Customer Focus
• Attention to Accuracy and Detail

Note: Company reserves the right to close the advert before specified closing date.

PHA has its head office in Westville, KwaZulu-Natal. It operates country-wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.