Medical Authorization jobs

Pre-Authorisation Nurse

Company: Affinity Life Limited
Location: Benoni
Department: Pre-Authorisation

About the Role

Affinity Life Limited is looking for a professional and detail-oriented Registered Nurse to join our Pre-Authorisation team.

The successful candidate will assess and process medical pre-authorisation requests, ensuring that services are approved or declined in line with applicable benefits, clinical guidelines, policies and protocols.

Key Responsibilities

• Assess and process pre-authorisation requests for medical services and treatment.
• Validate membership, benefits, waiting periods and policy exclusions.
• Approve or decline requests in accordance with clinical guidelines and protocols.
• Assess requests for hospitalisation, specialist visits, diagnostics, emergency and other medical services.
• Identify and mitigate potential waste, abuse and inappropriate utilisation of benefits.
• Request and review supporting medical documentation where required.
• Provide members and healthcare providers with pre-authorisation outcomes.
• Handle escalations, appeals and queries.
• Maintain accurate records and adhere to company policies, regulatory requirements and SLA turnaround times.

Requirements

• Matric.
• Diploma or Degree in Nursing.
• Registered Nurse (SANC registered).
• Minimum 2 years’ clinical nursing experience.
• Managed care/pre-authorisation experience will be advantageous.
• Knowledge of medical aid benefits and clinical coding.
• Working knowledge of ICD, BHF and CPT codes.
• Theatre and Trauma experience
• Computer literate with good administrative skills Key Attributes

Professional Detail-oriented Accountable Honest Flexible Hardworking

Interested candidates are invited to submit their CV to sithembile.rantai@affinityhealth.co.za

Applicants will be selected according to the vacancy criteria.

Work Location: In person