Claims Verification & Coding Lead (Casemix)

Siloam Hospitals Group (Tbk); Purwakarta; On-site; IDR 167,400,000 - 279,000,000; Full time

Job summary

Siloam Hospitals Purwakarta is seeking a Medical Billing and Casemix Lead to manage BPJS Kesehatan submissions and insurance claims. You will supervise the coding team, ensure documentation quality, and coordinate with medical and administrative units to optimize claim outcomes.

The role requires medical registration, familiarity with INA-CBG coding, and the ability to drive process improvements across departments. Fresh graduates may apply; strong collaboration with BPJS providers is essential.

Qualifications

• Bachelor of Medicine and Medical Profession (S1 Profesi Dokter) completed and registered.
• Fresh graduates are welcome to apply.
• Active Medical Registration Certificate (STR) required.
• Min 1 year of experience in Casemix, BPJS Kesehatan, and/or insurance is a plus.
• Knowledge of hospital workflows, medical documentation, coding, and BPJS Kesehatan and/or insurance claim processes is an advantage.

Responsibilities

• Manage submission and reimbursement processes for BPJS Kesehatan and insurance claims within timelines.
• Lead and supervise the OPD and IPD Coding Team to ensure accurate coding and compliance.
• Review completeness of medical and administrative documents required for claim submission.
• Coordinate with Specialists, RMO, Front Office, Coders, Casemix Manager, and related teams regarding changes or missing claim documentation.
• Review coding results and hospital billing details to ensure INA-CBG and insurance requirements compliance.
• Ensure submitted claims are in accordance with patient treatment and designated care class.
• Monitor the status of pending, disputed, rejected, and unresolved claims.
• Coordinate with Finance and Medical Teams to complete additional documents or clarifications for BPJS Kesehatan/insurance providers.
• Assist in resolving pending or disputed claims by coordinating with Casemix Manager, Specialists, RMO, Finance, BPJS Kesehatan, and providers.
• Analyze causes of pending or disputed claims and provide recommendations to improve claim effectiveness and optimization.

Skills

Active Medical Registration (STR)

Fresh graduates welcome

Casemix experience

BPJS/insurance knowledge

Hospital workflow knowledge

Education

S1 Profesi Dokter

Job description

Siloam Hospitals Purwakarta is seeking a Medical Billing and Casemix Lead to manage BPJS Kesehatan submissions and insurance claims. You will supervise the coding team, ensure documentation quality, and coordinate with medical and administrative units to optimize claim outcomes.

The role requires medical registration, familiarity with INA-CBG coding, and the ability to drive process improvements across departments. Fresh graduates may apply; strong collaboration with BPJS providers is essential.