Clinical Pre-Authorisation Consultant

Vacancy Details
Employer:
Medical Resources Group
Duties:
- Handling telephonic authorizations, hospital, and radiology on the pre-authorization call center.
- Capture clinical information and verify the information, including the applicable ICD-10 and item codes.
- Confirm membership status &
available benefits on the system before authorization can be granted.
- Validate and evaluate special pre-authorization requests.
- Ensure that the correct codes are used before benefits are approved.
- Clinical interpretation and analysis of medical reports and/or doctor's motivation.
- Important Company correct applicable information in respect of scheme rules, benefits &
approvals in respect ofall services required to patients and service providers.
- Approve benefits accurately according to the benefits per benefit option and strictly according to the protocols to reduce the Scheme's risk in respect of benefits.
- Accurate and complete capturing of all relevant information as well as approved documents on the appropriate operational systems.
- Deliver a high-quality service to the members and service providers.
- Keep abreast of amendments to scheme rules, benefit options, legislation, protocols, processes, and systems