Internal Verificator

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

Supported by its strategic location at the crossroads of Purwakarta, Subang, and Karawang regencies, Siloam Hospitals Purwakarta has become a trusted and high-quality health service provider at an affordable cost. Siloam Hospitals Purwakarta, which has been fully accredited by KARS, provides comprehensive health services with excellence in Cardiology, Neurology and Trauma equipped with Catheterisation Laboratory (Cathlab), 64 Slices CT Scan, C-Arm, ESWL (Extracorporeal Shock Wave Lithotripsy), Endoscopy, Laparoscopy and other latest medical equipment

Job Description

• Manage the submission and reimbursement processes for BPJS Kesehatan and insurance claims accurately, completely, and within the required timelines.
• Lead and supervise the OPD and IPD Coding Team to ensure accurate coding and compliance with applicable regulations.
• Review the completeness of medical and administrative documents required for claim submission.
• Coordinate with Specialists, RMO, Front Office, Coders, Casemix Manager, and related teams regarding any changes, discrepancies, or missing claim documentation.
• Review coding results and hospital billing details to ensure compliance with INA-CBG and applicable insurance requirements.
• Ensure that submitted claims are in accordance with the patient's treatment and designated care class.
• Monitor the status of pending, disputed, rejected, and unresolved claims submitted to BPJS Kesehatan and/or insurance providers.
• Coordinate with the Finance and Medical Teams to complete additional documents or provide clarifications required by BPJS Kesehatan and/or insurance providers.
• Assist in resolving pending, disputed, or inappropriate claims by coordinating with the Casemix Manager, Specialists, RMO, Finance Team, BPJS Kesehatan, and insurance providers.
• Analyze the causes of pending, disputed, or inappropriate claims and provide recommendations to improve claim effectiveness and optimization.
• Coordinate with the Casemix Manager and Medical Team to support claim optimization based on clinical aspects and medical documentation.
• Ensure that the coding and claim submission processes comply with BPJS Kesehatan regulations, insurance requirements, and hospital policies.
• Provide the latest information regarding changes in BPJS Kesehatan regulations and/or insurance requirements to relevant teams.
• Support the implementation of digital verification (VEDIKA) and claim verification processes in relevant units.
• Establish and maintain good working relationships with internal hospital teams, BPJS Kesehatan, and insurance providers.
• Support the implementation of effective processes to improve claim accuracy, completeness, and optimization while minimizing the risk of fraud.

Qualifications

• Bachelor of Medicine and Medical Profession (S1 Profesi Dokter).
• Fresh graduates are welcome to apply.
• Must have an active Medical Registration Certificate (STR).
• Minimum 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.

Additional Information

Healthcare Services More than 10,000 employees

Siloam International Hospitals (Siloam) is Indonesia’s most progressive and innovative healthcare provider that has set the benchmark for high quality healthcare services in Indonesia. Siloam’s medical team of more than 500 general practitioners, 2,200 specialist doctors, and 9,000 nurses, allied health, and support staff, offers international quality healthcare services to nearly two million patients annually.

With equal access to medical care in Indonesia still a challenge, Siloam’s business strategy allows its hospital to operate on a lower cost based on economic of scale.

Siloam International Hospitals (Siloam) is Indonesia’s most progressive and innovative healthcare provider that has set the benchmark for high quality healthcare services in Indonesia. Siloam’s medical team of more than 500 general practitioners, 2,200 specialist doctors, and 9,000 nurses, allied health, and support staff, offers international quality healthcare services to nearly two million patients annually.

With equal access to medical care in Indonesia still a challenge, Siloam’s business strategy allows its hospital to operate on a lower cost based on economic of scale.