Mitarbeiter (m/w/d) - MD-Management
Core
Managing medical service disputes, audits, and appeals for the MD-Management department, ensuring billing accuracy and compliance with DRG/PEPP systems.
Role type
Senior MD-Management Specialist (Medical Controlling)
Builds
Dispute resolutions, audit preparations, and administrative documentation for medical service claims.
Domain
Healthcare administration / Medical Controlling
Deliverable
client delivery
Required skills
DRG and PEPP billing systems, medical coding, medical service audit preparation, dispute resolution, administrative case management, medical process understanding, KIS/SAP/Excel proficiency
Preferred skills
MD-Management or medical controlling experience, medical-nursing background, coding specialist qualification
Responsibilities
Process claims and record data in the claims management tool, communicate with internal and external stakeholders regarding medical justifications, review MD reports and formulate objections, conduct dispute procedures and create appeals against payers, prepare and lead medical service audits, prepare administrative and substantive documentation for legal cases
