Siloam Hospitals Group

Private hospital network and healthcare provider

Casemix Manager

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeJakarta, IndonesiaNo salary listedIn-person

About the Job

Requirements

A bachelor's degree in any related major is required.
At least 2 years of work experience in healthcare or quality management is required.
Attention to detail to ensure accuracy in coding and data reporting is required.
Problem-solving skills to address and resolve issues related to case mix data and coding practices are required.
Proficiency with healthcare coding systems such as ICD, DRG, and other classification systems is required.

Responsibilities

Manage the quality and costs of patient services and care, and carry out strategic and operational initiatives, including analyzing patients by service unit, ensuring positive internal referrals, and building relationships with internal units and related external parties.
Collaborate with hospital leaders, including the CEO, Hospital Director, and AMA, on strategic planning and operational development.
Work with Finance to analyze gross margins by service type and treatment.
Analyze discrepancies between hospital billing rates and insurance reimbursements to identify opportunities to improve financial performance for insured patient cases.
Collaborate with the Siloam marketing and clinic team.
Hold regular meetings with Siloam clinics, non-Siloam clinics, and other related hospitals to obtain priority referrals.
Collaborate with AMA to improve the performance of low-utilization equipment.
Review and conduct daily supervision of insured inpatients based on daily reports from the RMO for inpatient cases.
Maintain estimated claim counts in the web application and communicate them to specialist doctors.
Discuss difficult or special cases with AMA and/or the Hospital Director.
Communicate with specialists, RMO, and pharmacy to review services, procedures, and examinations provided to insured patients from inpatient admission or daily reporting through discharge, including follow-up examinations.
Ensure rooms provided match the specified patient class and any patient top-up standards.

Desired Qualifications

A degree in a medical department is preferred.
Experience with quality projects or internal audits is a plus.

Job Description

Manage the quality and costs of services/care provided to patients and be responsible for carrying out various initiatives, both strategic and operational, including analyzing 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) in areas ranging from strategic planning to operational development
Collaborating with Finance to conduct an analysis of gross margins based on type of service (craft groups) and treatment
Analyze discrepancies between hospital billing rates and insurance reimbursements to identify opportunities for improved financial performance in insured patient 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.
Review and carry out daily supervision of insured inpatients based on daily reports from the 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.
Communicate with the medical team (specialists and RMO) and pharmacy to review the services, procedures, and examinations provided to insured patients, starting from the reception of IPD patients and/or based on daily reports until discharge, including any follow-up examinations..
Ensure that the rooms provided are in accordance with the specified patient class and/or patient top-up standards (if any).

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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