Pre - Authorization Agent

Position Purpose: To ensure the accurate issuing of appropriate pre-authorisations that meets the requirements of clinical appropriateness, medical necessity and clinical risk management.

Experience: A minimum of 2-3 years’ experience in Managed Healthcare will be advantageous.

Qualifications: A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered / Enrolled Nurse). (MANDATORY REQUIREMENT)

KEY PERFORMANCE AREAS

• Advise on best practice health risk solutions to relevant parties
• Application of clinical intervention principles
• Excellent understanding of Call Centre technology
• Application of financial and risk assessment methodology
• Authorise hospital authorisation requests by applying coding principles, scheme rules and benefits, and managed care policies and processes
• Capture accurate pre-authoris...