Hospital Pre-Auth Service Agent - Health Solutions

Health Solutions | Eastern Cape

Description : Hospital Pre-Auth Service Agent. Company : Health Solutions. Location : Eastern Cape

Introduction

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.


Role Purpose

To effectively contribute to the Pre-Authorisation Team, ensuring that the KPIs and SLAs are met and that all visits and in-room procedures are authorised according to protocol.


Requirements
  • National Senior Certificate with Life Sciences as a Grade 12 subject
  • Relevant health-related tertiary qualification including, but not limited to, BA Psychology, Biokinetics, Human Science, Diploma in Nursing.
  • Alternatively, the incumbent should have a proven track record of at least 5 years in the Pre-Authorisation field for a medical scheme
  • Excellent understanding of the medical scheme administration industry
  • MS Office Suite (Word, Excel, Outlook, etc.)
  • Relevant experience in a call centre environment
  • Exposure to medical claims and ICD-10 coding

Duties & Responsibilities
  • Pre-authorisation of all in-hospital procedures for applicable schemes, according to protocols, telephonically and via email
  • Pre-authorisation of all specialised radiology for all schemes, according to protocols
  • Pre-authorisation of all medical appliances and oxygen for all schemes
  • Ensure that all authorisations are completed within the specified time frame
  • Escalate complicated cases to the Pre-Auth Team Leader for presentation at the clinical committee meeting
  • Ensure accurate and comprehensive notes or documents are recorded on the system
  • Check and action the pending list daily to ensure that SLAs are met
  • Rotational filing of audit reports
  • Running of daily reports and distribution to the applicable case managers
  • Enhance member experience by providing exceptional customer service
  • Assisting the Specialist Pre-Auth team when necessary

Competencies
  • Telephone etiquette
  • Excellent verbal and written communication skills
  • Accountability
  • Time management
  • Attention to detail
  • Relationship building
  • Empathic nature
  • Teamwork and cooperation
  • Business administration skills