Deskripsi Pekerjaan
Are you an expert in hospital finance, clinical coding, and medical reimbursement? Siloam Hospitals Group, the leading healthcare provider in Indonesia, is seeking a dedicated Casemix Manager to join our team in Bangka Belitung. In this pivotal role, you will be responsible for overseeing the integrity of clinical documentation, ensuring accurate billing cycles, and optimizing the Casemix (INA-CBGs) performance to support the hospital's operational excellence.
You will lead a team of medical coders and administrative staff, working closely with clinical departments to ensure that patient records are accurately captured and mapped to the relevant reimbursement systems. This is an exceptional opportunity for a healthcare professional with a deep understanding of health insurance regulations and BPJS Kesehatan compliance to make a significant impact on hospital revenue and service quality.
Tanggung Jawab
- Lead and supervise the daily operations of the Casemix and Medical Coding department.
- Ensure 100% accuracy in clinical documentation, diagnosis coding, and procedural coding according to ICD-10 and ICD-9-CM standards.
- Monitor and analyze Casemix performance metrics to identify trends, claim rejections, and opportunities for revenue optimization.
- Coordinate with the billing and finance teams to reconcile discrepancies between clinical records and final claims.
- Conduct regular training and audits for clinical staff regarding the importance of precise documentation for reimbursement purposes.
- Manage relationships and communication with external payers, including BPJS Kesehatan and private insurance providers.
- Prepare comprehensive reports for hospital management regarding claim status, rejection analysis, and financial performance.
Kualifikasi
- Bachelor’s degree in Healthcare Management, Medicine, Nursing, Public Health, or a related field.
- Minimum of 3-5 years of experience in Casemix management, hospital administration, or medical billing/coding.
- Certified professional in ICD-10 coding and familiar with the INA-CBGs system.
- Deep understanding of the Indonesian healthcare system, BPJS regulations, and insurance claim processes.
- Strong analytical skills with the ability to interpret complex data and translate it into actionable strategies.
- Excellent leadership abilities and experience in managing diverse healthcare teams.
- Proficiency in Hospital Information Systems (HIS) and Microsoft Office Suite.