Casemix Manager

Siloam Hospitals Group; Kota Yogyakarta; On-site; IDR 180,000,000 - 300,000,000; Full time

Job summary

Siloam Hospitals Group in Yogyakarta seeks a qualified healthcare quality manager to oversee BPJS services, analyze case mix, and drive strategic initiatives. You will work with hospital leadership to improve margins, optimize referrals, and coordinate with medical and marketing teams.

This role emphasizes precision in coding and data reporting, with a focus on patient care quality and operational efficiency.

Qualifications

• Bachelor degree in Medicine or equivalent and licensed physician.
• Minimum 2 years of work experience in health or quality management.
• Experience in quality projects or internal audits is a plus.
• High attention to detail to ensure accuracy in coding and data reporting.
• Proficiency with ICD, DRG, and other healthcare classification systems.

Responsibilities

• Manage BPJS service quality and costs; drive strategic and operational initiatives.
• Collaborate with hospital leaders on BPJS planning and development.
• Analyze gross margins for BPJS by service type.
• Monitor billing vs BPJS reimbursements to identify profitable cases.
• Coordinate with marketing and clinic teams.
• Lead regular meetings with clinics to secure priority referrals.
• Work with AMA to improve low-utilization equipment performance.
• Build and expand Siloam's healthcare network.
• Collaborate with medical team to optimize BPJS patient ALOS.
• Review BPJS daily reports from RMO for IPD cases.
• Track claims in the web app and share with specialists.

Skills

Quality management

Data analysis

Cross-functional collaboration

Attention to detail

ICD/DRG coding

Education

Bachelor Degree in Medicine

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.

Qualifications

• Bachelor Degree from Medicine doctor
• 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.