Spezialist im Leistungsbereich der Krankenversicherung - GOÄ, Kinderwunsch und Waste (m/w/d)
Core
Reviewing medical bills under the German Physicians' Fee Schedule (GOÄ) for private health insurance, focusing on surgeries, anesthesia, and fertility treatments, while identifying waste and optimizing costs.
Role type
Specialist in private health insurance claims adjudication
Builds
Medical necessity determinations and reimbursement decisions for insured members
Domain
German private health insurance / Medical billing compliance
Required skills
GOÄ fee schedule expertise, medical billing knowledge, analytical reasoning, negotiation skills, decision-making, cost optimization
Preferred skills
Experience with digital collaboration, agile methodologies, project management
Technologies
Digital collaboration tools, agile project management frameworks
Responsibilities
Reviewing physician invoices for medical necessity and content accuracy; Corresponding with insured members, intermediaries, and medical billing offices; Identifying error sources and waste; Contributing to GOÄ updates and cost stabilization projects
