Port Elizabeth, Eastern Cape, ZA
1d ago
source : Work-Force
  • Registered Enrolled Nurse
  • Excellent understanding of the Medical Scheme Administration industry
  • Good computer skills essential
  • Working experience in a private hospital
  • Relevant experience in call centre an advantage
  • Ability to work within a team
  • Exposure to claims and ICD10 coding would be advantageous
  • Excellent communication skills
  • Responsibilities :

  • Pre-authorisation of all in hospital procedures for applicable Schemes, according to CRM protocols, telephonically and via email.
  • Pre-authorisation of all specialised radiology for all Schemes, according to CRM protocols
  • Pre-authorisation of all medical appliances and oxygen for all Schemes
  • All authorisations need to be completed within 48 hours of receipt
  • Answering the telephone within 15 seconds (maintain KPIs)
  • Escalate complicated cases to CRM pre auth Team leader for presentation at the clinical committee meeting
  • Ensure that accurate and comprehensive notes are recorded on the system
  • Document savings
  • Check pending list daily and must not exceed 14 days
  • Rotational filing of audit reports. Running of daily reports and distribution to the applicable Case Managers
  • Maintain quality customer service
  • Apply the company values in the workplace.
  • Enable client centricity within area of responsibility :

  • Continuously meet turnaround times, uphold quality standards and resolve issues speedily to enhance client service delivery
  • Ensure that clients receive appropriate advice and after authorisation service.
  • Accurately resolve client queries and ensure excellent client service
  • Build and maintain relationships with clients and providers
  • Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service
  • Self Management and Teamwork :

  • Demonstrate exemplary team behaviour, through personal involvement, commitment and dedication in support of organisational values.
  • Be part of a culture that directs best practice, fostering an environment of continuous learning, improvement and cohesiveness.
  • Identify own growth and development needs and discuss interventions to enable ongoing development, training and personal growth.
  • Effectively manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
  • Encourage innovation
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