Dental Risk Consultant

Job Description,

An exciting and challenging opportunity for an energetic, attention to detail results focused Dental Risk Consultant exists. The successful candidate must have experience and exposure in Dental Risk Management and will act as an Ambassador for PPSHA to ensure effective customer query resolution.

, Requirements,

Grade 12

Bachelors Degree

Dental Risk Management is essential

Sound knowledge of the Coding Systems: ICD10 & CPT4 Principles and sound knowledge of the Medical Aid Industry, Rules & Regulations, ISO and other related legislation

Excellent business writing & communication skills with exceptional telephone etiquette

Must have strong organisational awareness to anticipate the impact of actions on other groups.

Time Management & good administration skills

Must be a strong team player and results driven

Computer literacy (MS Office and Medical Administration system)

, Duties and Responsibilities,

• Ensure a successful & smooth pre-authorisation and case management process telephonically in a call centre environment, via email and online chat.
• Ensure adherence to Scheme Rules on all Authorisations and clinical updates.
• Ensure correct allocation of facilities for our members.
• Effective handling of Internal/External Clinical Queries Communicate with members and service providers in order to address hospital utilisation matters
• Assist with Dental Risk Management Monitoring & Management of hospital re-admissions
• Compile & submit detailed reports to the Scheme on costs and patient’s progress