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Business Writer
Job Title
Clinical Hospital Pre-Auth Service Agent
Employment Type
Full Time
Experience
2 to 3 years
Salary
Negotiable
Job Published
04 August 2022
Job Reference No.
2310079025

Job Description

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.

 

 

 

 

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