Internal Verificator

Responsibilities

• Manage the submission and reimbursement of BPJS claims
• Lead and review the work of OPD and IPD Coders to ensure optimization and timeliness
• Verify completeness of documentation required for claim submission
• Communicate with Specialists, Front Office, and Coders regarding documentation changes
• Review coding input and hospital billing details in accordance with INA-CBG
• Monitor and manage pending or disputed claims with BPJS and Finance
• Collaborate with medical teams and Casemix Managers to resolve claim issues
• Develop BPJS SOPs and ensure compliance with regulations to prevent fraud
• Support the implementation of digital verification (VEDIKA) in units

Requirements

• Bachelor's Degree in Healthcare Administration, Health Information Management, Accounting, or a related field
• Minimum 2 years of working experience in BPJS operations
• Strong analytical skills for interpreting complex data and identifying discrepancies
• High attention to detail for auditing and verification processes
• Understanding of internal controls and operational efficiency best practices