Internal Verificator

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

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.