Pre Auth Consultant (TALENT POOL) MMH250811-3

Role Purpose

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

Requirements

• Matric
• Registered/ Enrolled Nurse is advantageous
• 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(240 seconds Handling time per call).
• Maintain quality customer service.
• Bin management turn-around time of 48 hours.
• Implementation of policies / protocols related to scheme benefits.
• Benefits in and out of hospitalis appropriately controlled.
• Exclusions are correctly and consistently applied.
• Positive relationships are built and maintained with hospitals and providers.
• Appropriate referral to case management team.

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