Job Description
Full details about the role and requirements
Yukerja Summary
The Casemix Unit Head role at Bundamedik is curated from JobStreet (category Teknologi & IT). Note the work location (Bekasi, West Java) before applying. Yukerja.com is not the employer — applications are handled on the official source site.
Qualifications
Medical Doctor (Profesi Dokter) with an active STR.
Minimum 2 years of experience in CaseMix, Medical Record, Claims Management, or related field in a hospital.
Strong understanding of Case Based Groups (CBGs) and INA-CBGs payment systems.
Familiar with BPJS Kesehatan regulations related to hospital claims.
Good understanding of hospital tariffs, severity levels, coding, and factors affecting claim reimbursement.
Excellent communication and interpersonal skills with the ability to collaborate effectively with internal and external stakeholders.
Strong analytical, problem-solving, and leadership skills.
Key Responsibilities
Lead and oversee the hospital's CaseMix unit to ensure effective and accurate claims management.
Conduct pre-verification of BPJS claims prior to submission to ensure completeness and compliance.
Monitor and evaluate hospital claim performance, including claim acceptance rates, pending claims, and dispute resolutions.
Analyze claim trends and identify opportunities to improve claim quality and reimbursement outcomes.
Ensure compliance with BPJS regulations, INA-CBGs guidelines, and applicable healthcare policies.
Coordinate with medical, nursing, medical records, coding, finance, and other related departments to optimize the claims process.
Provide recommendations and continuous improvement initiatives to enhance the efficiency and effectiveness of the CaseMix function.