SUMMARY:
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POSITION INFO:
Our client in the Insurance Industry based in Port Elizabeth is currently looking to employ a Clinical Hospital Pre-Authorisation Service Agent.
An awesome career opportunity awaits!
Requirements:
- Grade 12 Certificate – Essential.
- Degree or Diploma in General Nursing – Essential.
- Valid South African Nursing Council Registration – Essential.
- MS Office Suite Experience – Essential.
- 2 - 3 Years' experience in a private hospital – Essential.
- Relevant experience in a call centre environment – Advantageous.
- Exposure to claims and ICD-10 coding – Advantageous.
- Understanding of the Medical Scheme Industry – Advantageous.
Responsibilities:
- Pre-authorisation of all in-hospital procedures for applicable schemes, according to CRM protocols, telephonically and via email.
- Pre-authorisation of all specialised radiology for all schemes, according to CRM protocols.
- Pre-authorisation of all medical appliances and oxygen for all schemes.
- Assistance with clinical related queries and escalations where applicable.
- Presenting of complicated cases at clinical meetings when required.
- Accurate and comprehensive recording of notes on the system.
- Rotational filing of audit reports.
- Running of daily reports and distribution to the applicable case managers.
- Accurately resolve client queries and ensure excellent client service.
- Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
- Demonstrate exemplary team behaviour through personal involvement, commitment and dedication in support of organisational values.
- Be part of a culture that directs best practice, fostering an environment of continuous learning, improvement and cohesiveness.
- Identify own growth and development needs and discuss interventions to enable ongoing development, training and personal growth.
- Deal with ambiguity, uncertainty and provide perspective in difficult situations.
Please note should you not receive a response within two weeks of applying please consider your application unsuccessful.
NB! This job is now closed. You can apply for other jobs by uploading your CV.
