Mitarbeiter (m/w/d) für die Plausibilitätsprüfung im Fachbereich Plausibilitäts- und Kassenverfahren
Core
Verify the accuracy and traceability of medical billing submissions from over 5,000 outpatient physicians and psychotherapists in Brandenburg, analyze billing anomalies, and prepare documentation for the Billing Committee.
Role type
Billing compliance specialist (healthcare)
Builds
Audit reports, official decisions (Bescheide), and decision templates for the Billing Committee
Domain
German statutory health insurance (GKV) and outpatient physician billing
Required skills
Medical billing verification, anomaly detection, knowledge of statutory health insurance regulations, EBM (German fee schedule) knowledge, report writing, meeting preparation
Preferred skills
Experience with contract physician billing systems, EBM expertise, experience creating official decisions
Technologies
EBM, German statutory health insurance billing systems
Responsibilities
Review member billing submissions for accuracy and traceability, identify and investigate billing anomalies, analyze legal and contractual regulations in outpatient care, prepare and document sessions of the Billing Committee, create audit reports and official decisions, communicate with members regarding billing questions
Seniority
Mid-level, structured and independent worker