Posted on: 23 July 2024
ID 919810

Clinical Preauth Consultant x3 MMH231012-4

Role Purpose

To ensure best practice is followed in providing medical care and treatment.

Requirements
  • Matric.
  • Enrolled or Registered Nurse.
  • 2-3 years experience within the managed care industry.
  • Excellent understanding of the scheme products and legislation.
  • Effective management of scheme rules in line with clinical guidelines.
  • Knowledge of PMB guidelines.
  • Telephonic etiquette.
Duties and Responsibilities
  • Attain daily KPI of 70 ;meet the prescribed number of calls (240seconds Handling time per call).
  • Maintain quality customerservice.
  • Bin management turn- aroundtime of 48 hours.
  • Implementation ofpolicies/protocols related toscheme benefits.
  • Benefits in and out of hospital isappropriately controlled.
  • Exclusions are correctly andconsistently applied.
  • Positive relationships are builtand maintained with hospitalsand providers.
  • Appropriate referral to casemanagement team.
-346021296

Occupation:
Finance jobs


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