Siloam Hospitals Group

Private hospital network and healthcare provider

Casemix Manager

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeCentral Bangka Regency, Bangka Belitung Islands, IndonesiaNo salary listedIn-person

About the Job

Requirements

A bachelor's degree from any related major is required; a medical department major is preferred.
At least 2 years of work experience in healthcare or quality management is required.
Experience in quality projects or internal audit is an advantage.
Attention to detail to ensure accuracy in coding and data reporting.
Problem-solving skills to address issues related to case-mix data and coding practices.
Proficiency with coding systems such as ICD, DRG, and other healthcare classification systems.

Responsibilities

Manage the quality and costs of services and care provided to BPJS patients, including strategic and operational initiatives, analysis of BPJS patients by service unit, supporting positive internal referrals, and building relationships with relevant internal units and external parties.
Collaborate with hospital leaders, including the CEO, Hospital Director, and AMA, on BPJS matters from strategic planning through operational development.
Work with Finance to analyze gross margins for BPJS patients by service type and treatment.
Monitor differences between hospital billing rates and BPJS reimbursement amounts to identify more profitable BPJS cases.
Collaborate with the Siloam marketing and clinic teams.
Hold regular meetings with Siloam clinics, non-Siloam clinics, and other relevant hospitals to secure priority referrals.
Collaborate with AMA to improve the performance of underutilized equipment.
Build and expand Siloam's network in the health industry.
Work with the medical team to manage the average length of stay for BPJS patients.
Review BPJS patients' cases daily and supervise them using daily reports from RMO for IPD cases.
Maintain estimated claim amounts in the web application and communicate them to specialist doctors.
Discuss difficult or special cases with AMA and/or the Hospital Director.
Work with the Hospital Director to build good relationships with the relevant BPJS organization.
Provide the BPJS team, including clinical and administrative staff, with current information on BPJS regulatory developments and updates.
Coordinate with specialists, RMO, and pharmacy to review services, procedures, and examinations provided to BPJS patients from IPD admission through discharge, including follow-up examinations.
Advise the medical team on cases to refer back to a clinic or Puskesmas, or to another hospital, according to patients' needs and conditions.
Ensure rooms match the specified patient class and any patient top-up standards.
Supervise prescription-drug and consumable-goods use for BPJS patients.
Review the status of case claims recorded by the Internal Verifier in the application.
Collaborate with Internal Verifiers and specialists to resolve claims rejected by BPJS.
Ensure compliance with BPJS regulations and prevent fraud.

Desired Qualifications

A medical department major is preferred.
Experience in quality projects or internal audit is an advantage.

Job Description

•Manage the quality and costs of services/care provided to BPJS patients and be responsible for carrying out various initiatives, both strategic and operational, including analyzing BPJS patients by each service unit, ensuring positive internal referrals, and building good relationships between units and related external parties.

•Collaborate with hospital leaders (CEO, Hospital Director, AMA) related to BPJS, starting from strategic planning to operational development.

•Collaborating with Finance to conduct an analysis of gross margins for BPJS patients based on type of service (craft groups) and treatment.

•Monitor the difference between hospital billing rates and BPJS reimbursement amounts to identify more profitable BPJS cases.

•Collaborating with the Siloam marketing and clinic team.

•Hold regular meetings with Siloam clinics, non-Siloam clinics and other related hospitals to get priority referrals.

•Collaborate with AMA to improve performance of low utilization equipment.

•Building and expanding Siloam's network in the health industry.

•Collaborate with the medical team to manage the average length of stay (“ALOS”) for BPJS patients.

•Review and carry out daily supervision for BPJS patients based on daily reports from RMO for IPD cases.

•Maintaining the estimated number of claims in the web application and communicating it with specialist doctors.

•Conduct discussions with AMA and/or Hospital Director regarding difficult or special cases.

•Collaborate with the hospital director to build good relations with the relevant BPJS.

•Provide the latest information to the BPJS team (both clinical and administrative staff) regarding developments or updates in BPJS regulations.

•Communicate with the medical team (specialists and RMO) and pharmacy to review the services/procedures/examinations provided to BPJS patients, starting from the reception of IPD patients and/or based on daily reports until the patient is discharged (including if there are follow-up examinations).

•Provide advice to the medical team about cases that will be referred back to the clinic/Puskesmas or to refer to another hospital according to the patient's needs and condition.

•Ensure that the rooms provided are in accordance with the specified patient class and/or patient top-up standards (if any).

•Supervise the use of prescription drugs and consumption of consummable goods for BPJS patients.

•Review the status of case claims recorded by the Internal Verificator in the application.

•Collaborate with Internal Verifiers and specialists to resolve problems related to claims rejected by BPJS.

•Ensure compliance with BPJS regulations and prevent cases of fraud.

•Bachelor Degree from any related major (preferably in Medical Department)

•any related major (preferably in Medical Department)

•Have minimum 2 years work experience in the field of health or quality management, having experience in quality projects or internal audit will be plus

•High attention to detail to ensure accuracy in coding and data reporting.

•Strong problem-solving skills to address and resolve issues related to case mix data and coding practices.

•roficiency with coding systems such as ICD, DRG, and other classification systems used in healthcare.

Qualifications

•Bachelor Degree from any related major (preferably in Medical Department)

•Have minimum 2 years work experience in the field of health or quality management, having experience in quality projects or internal audit will be plus

•High attention to detail to ensure accuracy in coding and data reporting.

•Strong problem-solving skills to address and resolve issues related to case mix data and coding practices.

•roficiency with coding systems such as ICD, DRG, and other classification systems used in healthcare.

Additional Information

[BEWARE OF RECRUITMENT SCAMS]

It has come to our attention that there are fake job offers claiming to be hiring for Siloam Hospitals Group. Please note that Siloam Hospitals Group do not require applicants to make payment when seeking employment with our hospitals.

About the Company

Siloam Hospitals Group

Private hospital network and healthcare provider

Siloam Hospitals Group runs a large private healthcare network in Indonesia with 41 hospitals and many clinics across 23 provinces. It delivers inpatient and outpatient services to self-paying patients, corporate clients, insurers, and BPJS participants, generating revenue from room charges, procedures, consultations, pharmaceuticals, and diagnostics. The group focuses on high-complexity care in cardiology, oncology, neurology, neurosurgery, orthopedics, and gastroenterology, operating Centers of Excellence to coordinate advanced treatments, and uses a managed service model that lets hospitals be built with external capital while sharing revenue. Its goal is to expand access to high-quality private healthcare in Indonesia, strengthen specialized care, and maintain a broad, affordable service network for individuals, employers, insurers, and government programs, backed by JCI accreditation as a quality benchmark.

Company size: 5,001-10,000
Company stage: IPO
Headquarters: Tangerang, Indonesia
Founded: 1996

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