Clinical Hospital Pre-Authorisation Service Agent

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.