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Pre-Authorization Consultant

Job Description

Location: Port Elizabeth

Availability: Immediately

Key Outputs                       

Required to be logged on the queue for 7 hours per day

Managing inbound telephone queries and requests

Verify memberships

Accurately obtain and capture information to confirm correct funding

Ensure that the reason for admission is appropriate

Having an understanding of ICD, BHF and CPT codes

Capture comprehensive remarks on Paradigm and the Company Care system

Confirm benefits according to set protocols and funding rules

Provide product information to all Company and Inhouse clients in line with the  standards and protocols

Transfer calls not related to Pre-Authorisation, to the relevant department

Liaise with other internal departments to resolve queries on First contact

Resolving a query on the initial contact

Maintain confidentiality

Working on DH systems, i.e. Paradigm, CompanyCare and Discribe

Send communication via DiScribe to clients

Follow-up on urgent queries and inquiries

Maintaining acceptable (on – par) performance in the following areas:               

EMBR, DPMO and AHT

 

Competencies                  

Assertive

Empathetic

Committed

Ability to cope with pressure and demands

Communicate clearly, concisely and professionally

Display professional behaviour

Uses listening skills to identify problems

Self-motivated

Team player

Trouble-shooting and Problem Solving Skills

Time Management

Driven to resolve queries to resolution and driven by ownership

Decision making skills

Ability to convey negative and unfavourable messages

Questioning Skills

Ability to deal with client complaints, queries and benefit explanations

Risk Management

Ability to consolidate and process a variety of information

 

Qualifications & Experience      

Essential

Matric

Registered Medical qualification

Knowledge of Anatomy/Physiology

Advantageous

Minimum of 6 months call centre experience

Minimum of 6 months customer service experience

 
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