Internal Verificator (Casemix Department)

Siloam Hospitals Group; Tangerang; On-site; IDR 100,440,000 - 145,080,000; Full time

Benefits offered by this job

BPJS health program support

Job summary

Siloam Hospitals Group is seeking an Internal Verificator in the Casemix Department for a full-time role. You will manage BPJS claim submissions and reimbursements, and lead Coders (OPD and IPD) while ensuring complete and timely submissions.

You will verify document completeness, coordinate with Specialists, Front Office and Coders, and review coding inputs to ensure accuracy in hospital billing and adherence to INA-CBG guidelines.

Qualifications

• Bachelor Degree in Healthcare Administration, Health Information Management, Accounting, or related major.
• Active Medical Registration Certificate (STR).
• Minimum 2 years of BPJS operations or Casemix experience.
• Knowledge of BPJS Kesehatan claim processes and hospital workflows.

Responsibilities

• Manage submission and reimbursement of BPJS claims and lead Coders (OPD/IPD).
• Review coding input and hospital billing details for accuracy.
• Check completeness of documents required to submit a claim.
• Communicate with Specialists, Front Office and Coders for changes in claim documentation.
• Monitor pending/disputed/inappropriate claims and coordinate with Finance and BPJS to resolve issues.
• Collaborate with Casemix Manager, Specialist, RMO and BPJS on processes and SOPs.

Skills

Analytical skills

Attention to detail

Internal controls

Data auditing

Communication

Education

Healthcare Administration / Health Information Management / Accounting (any related major)

Bachelor of Medicine and Medical Profession (S1 Profesi Dokter)

Job description

Internal Verificator (Casemix Department)

• Full-time
• Manage the submission and reimbursement of BPJS claims as well as lead Coders (OPD and IPD) and review their work to ensure claim submission and coding optimization is complete and on time.
• Check the completeness of the documents required to submit a claim.
• Communicate with Specialists, Front Office and Coders for any changes to claim documentation.
• Review coding input and hospital billing details in accordance with INA-CBG carried out by Coder.
• Ensure that claims submitted are in accordance with the specified patient care class.
• Monitor and manage the list of claims that have not received feedback from BPJS, as well as the reimbursement status of claims that have received feedback from BPJS via Finance.
• Obtain information from Finance and collect additional documents as required by BPJS and/or related explanations required within 3 working days.
• Collaborate with Finance and medical teams (e.g. Casemix Manager, Specialist, RMO) as well as BPJS to resolve issues related to pending/disputed/inappropriate claims.
• Monitor the reasons for pending/disputed/inappropriate claims and periodically develop BPJS SOPs.
• Communicate with Casemix Manager regarding clinical practices that can assist in optimizing the number of claims.
• Provide the latest information to the BPJS team (both clinical and administrative staff) regarding developments or updates in BPJS regulations.
• Ensure compliance with BPJS regulations and prevent fraud cases
• Building good working relationships with BPJS verifiers
• Bachelor Degree from Healthcare Administration, Health Information Management, Accounting, or any related major
• Healthcare Administration, Health Information Management, Accounting, or any related major
• Have minimum 2 years working experience in the field of BPJS operations.
• Have strong analytical skills to review and interpret complex data and identify discrepancies.
• High attention to detail to ensure accuracy in auditing and verification processes.
• Understanding of internal controls and best practices for ensuring data accuracy and operational efficiency.

• Bachelor of Medicine and Medical Profession (S1 Profesi Dokter).
• 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.