Casemix Manager

Located in the business district of South Jakarta, Siloam Hospitals Simatupang has become a trusted private hospital for locals and foreigners living in the South Jakarta area. The hospital provides all kinds of quality healthcare services, especially through its excellent services in cardiology, neurosciences, orthopaedics and radiation oncology. With modern medical equipment and tools, the specialists, general practitioners, nurses, and support staff at Siloam Hospitals Simatupang are committed to providing patients with international-standard healthcare and services.

• Manage the quality and costs of services/care provided to patients and be responsible for carrying out various initiatives, both strategic and operational, including analyzing 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) in areas ranging from strategic planning to operational development
• Collaborating with Finance to conduct an analysis of gross margins based on type of service (craft groups) and treatment
• Analyze discrepancies between hospital billing rates and insurance reimbursements to identify opportunities for improved financial performance in insured patient 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.
• Review and carry out daily supervision of insured inpatients based on daily reports from the RMO for IPD cases
• Maintaining the estimated number of claims in the web application and communicating it with specialist doctors.
• Conduct discussions with AMA and/or Hospital Director regarding difficult or special cases.
• Communicate with the medical team (specialists and RMO) and pharmacy to review the services, procedures, and examinations provided to insured patients, starting from the reception of IPD patients and/or based on daily reports until discharge, including any follow-up examinations..
• Ensure that the rooms provided are in accordance with the specified patient class and/or patient top-up standards (if any).

•Bachelor Degree from any related major (preferably in Medical Department)

•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.

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