Medical Aid Pre-Authorisation Officer

Overview

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.