Pre-Authorisation Consultant

SUMMARY:
A well-established company located in Johannesburg North is looking for a Pre-Authorisation Consultant to join their team!

POSITION INFO:
Requirements:

• Nursing diploma (enrolled or registered nurse) or paramedic qualification.
• 3–5 years of experience in pre-authorization within managed healthcare.
• Knowledge of PMB conditions, clinical guidelines, ICD-10 codes, and hospital systems.
• Familiarity with medical scheme regulations and billing procedures.

• Authorize hospital admissions per scheme guidelines.
• Verify in-hospital benefits and funding.
• Manage surgical and medical cases within defined cost limits.
• Handle queries related to designated service providers, co-payments, and penalties.
• Refer complex and high-cost cases for further review.
• Maintain up-to-date knowledge of product changes and clinical guidelines.
• Achieve service delivery targets, including call center SLAs.