ROLE PURPOSE
To effectively contribute to the Hospital Pre-Auth Team, ensuring that the KPI's and SLA's are met and that the hospital procedures are authorised according to protocol. 

MINIMUM REQUIREMENTS

• Matric/Grade 12/ National Senior Certificate.
• Degree/ Diploma in General Nursing is ESSENTIAL
• Valid South African Nursing Council Registration (SANC) - Essential
• MS Office Suite Experience - Essential
• 2-3 Years' experience in a private hospital - Essential
• Language proficiency in English, Afrikaans and one other South African Language would be advantageous.
• Relevant experience in a call centre environment would be advantageous. 
• Exposure to claims and ICD-10 coding would be advantageous.
• Understanding the Medical Scheme Industry would be advantageous.
• SA citizens only.
• Clean criminal history.

DUTIES AND 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 medial appliances and oxygen for all schemes.
• Assistance with clinical-related queries and escalations where applicable.
• Presenting 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, facilities feedback and provides exceptional client service. 
• Demonstrate exemplary team behaviour through professional involvement, commitment and dedication in support of organisational values.
• Be part of a culture that directs best practices, 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, and uncertainty and provide perspective in difficult situations.

BEHAVIOURAL COMPETENCIES 

• Telephone etiquette and communication, verbal and written.
• Accountability.
• Time management.
• Attention to detail.
• Relationship building and interpersonal understanding.
• Customer orientation and results orientation. 
• Empathetic.
• Teamwork and cooperation.
• Business administration skills.
• Assistance with clinical-related queries and escalations where applicable. 

Ref Code: PRE
Location: Port Elizabeth / Gqeberha
Career Level: Junior to Mid
Industry: Healthcare
EE/ Non-EE: EE only
Working Hours: Monday to Friday (no weekend work)
Salary: R negotiable (package includes medical aid and provident fund)

Note:  All shortlisted candidates will be required to undertake, an online assessment and background and fingerprint clearance will be required at offer stage.

Applicants who have not heard from u within two (2) weeks from the closing date, which is 15 August 2022, should consider their application unsuccessful.