Job Description

Overview

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We are looking for a

Medical Aid Pre-Authorisation Officer

for one of our clients. In this role, you will be responsible for securing pre-authorisations from medical aids, verifying patient benefits, and ensuring all services are cleared for cover before treatment takes place. You will play a key role in preventing claim rejections and ensuring smooth coordination between patients, providers, and medical aids.

Key Responsibilities

Obtain pre-authorisations from medical aids for scheduled procedures and treatments. Verify patients membership, benefits, and eligibility prior to appointments. Collect and submit the required clinical documentation for pre-authorisation requests. Track pending authorisations and follow up to ensure timely approvals. Communicate authorisation outcomes to doctors, billing, and scheduling staff. Record all authorisation and verification activities accurately in the practice management/EMR system. Handle pre-authorisation denials by submitting additional information or lodging appeals where needed. Stay up to date with medical aid rules, authorisation processes, and policy changes.

Qualifications

Minimum of 2 years experience in medical aid pre-authorisations and benefits verification. Solid understanding of South African medical aid schemes, rules, and clinical terminology. Proficiency in EMR/practice management and billing systems. Strong attention to detail and excellent organisational skills. Clear communication skills for liaising with medical aid representatives, doctors, and patients. Ability to work independently and manage multiple priorities. * Familiarity with CentralReach is an advantage but not required.