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Pre Auth Agent

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Reference: 

12.2020

Location: 

Benoni

Source: 

National Risk Managers ( Affinity Health)

 

Job Summary

  • Handle pre-authorization requests as per set standard

 

Key Performance Areas/Key Responsible Areas

Receive Pre-Authorisation request

  • Answer calls according to set standards

  • Attend to email requests for all services which require pre-authorization

  • Check validity of membership.

  • Maintain accurate details of pre-authorization information

  • Confirm/decline benefits according to set protocols

  • Confirm that the reason for admission is appropriate as per business protocols by requesting motivation letters and treatment plans

  • Capture and update case notes on the system.

  • Provide authorisation numbers for cases loaded.

  • Advise customers if case has been declined

  • Provide product information to all clients in line with standards and protocols of the business

 

Action pre-authorization

  • Determine clients admission requirements

  • Review requested documents from referred Physicians/Health Care Providers to establish the reason for admission.

  • Verify diagnosis codes on treatment plans/medical reports are accurate and payable

  • Communicate with customers/physicians to request additional documentation as needed

  • Load all cases on relevant systems to facilitate information sharing within the team.

  • Create and email Guarantee of payment to Health care providers.

  • Follow up on admitted members and inform them on benefits and limits to specific case.



Perform administrative duties

  • Add updated case notes and close case on relevant systems.

  • Conduct and submit periodic reports (Daily and weekly)

 

Industry: 

Admin

Job Type: 

Permanent

Date Posted: 

2020-12-14

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