Analysis Of Outpatient Coder Workload Towards Optimizing Jkn Claims At Rsud Al Ihsan

Abstract

National Health Insurance (JKN) claims are an important component of the hospital financing system, which demands an accurate and timely administration process. Coders play a role in translating medical diagnoses and actions into standardized codes as the basis for claims. High coder workload can hinder the effectiveness of claim submission. This study aims to determine the workload of outpatient coders and its relationship to the optimization of JKN claims at the JKN Installation of Al Ihsan Hospital, West Java Province. The research method used was descriptive quantitative with a case study approach. Data were obtained through direct observation and secondary documentation, and calculated using the Health Workload Analysis (ABK-Kes) method. The results showed that the ideal number of outpatient coder officers needed was 33 people, while the actual number was only 6 people. This imbalance caused a claims processing deficit of 6,600 files per month, which resulted in delays and decreased coding quality. The conclusion of this study is that workloads that do not match the capacity of personnel have an impact on the effectiveness of the JKN claims process. Optimizing claims requires adjusting the number of human resources based on workload, periodic training, and adequate information system support.