Case Co-ordinator at Smith+Nephew

• An excellent opportunity has arisen within our Market Access Division for a Case Co-ordinator in Gauteng. The incumbent is responsible for the process of obtaining re-imbursement for Negative Pressure Wound Therapy in the Private Sector.
• This will be conducted in alignment with marketing and sales strategies to ensure short, medium- and long-term profitability of the Market Access products.

Sound Exciting? We believe so!
Essential Job Functions
Key Functions:

• To manage and monitor the process to facilitate re-imbursement through completed pre-authorization and ongoing progress report forms per patient.
• To work, closely with the sales team by ensuring the NPWT cases are submitted timeously in order to receive authorisations from medical funders.

Case Management
Manages and monitors the pre-authorization process by facilitating re-imbursement of NPWT by ensuring completed:

• Motivation forms
• Progress reports
• Appeal of decline cases

Participates in weekly Clinical Support meetings to ensure that their allocated region cases are tracking per ePATs
Submits monthly reports as required by management, which include:

• Decline Report
• WCA Report
• RAF Report
• Claims Management Report

Develops and maintains a key contact database

• Medical Funder Contacts
• Private Nurse Practitioners
• Provides feedback on daily work allocation
• Provides a weekly tracker report

Requirements
Education:

• Matriculation
• Clinical Background/Medical degree
• Administration diploma/degree

Experience:

• Proven experience in an administrative role, preferably in a medical aid or clinical environment
• Previous nursing experience
• Knowledge of the medical aid and wound care industry
• Customers Service experience
• Fully computer literate
• Good numeracy skills