Sachbearbeiter Leistungsprüfung - DRG/PEPP (m/w/d)
Core
Reviewing inpatient billing claims for psychiatric and psychosomatic care to ensure medical plausibility, correct diagnosis/procedure coding, and compliance with DRG/PEPP billing rules.
Role type
Claims adjudication specialist (DRG/PEPP)
Builds
Validated billing claims and patient cost estimates for private clinics
Domain
Health insurance / Medical billing / Psychiatric care
Required skills
Psychiatric and psychosomatic clinical experience, DRG/PEPP billing regulations, ICD-10-GM and OPS coding, German coding guidelines (DKR/DKR-Psych), cost estimation, stakeholder communication
Preferred skills
Medical controlling background, experience with claims verification tools, prior experience in health insurance or Medical Service
Technologies
DRG/PEPP systems, ICD-10-GM, OPS, DKR/DKR-Psych guidelines
Responsibilities
Verify medical plausibility of diagnoses and treatments in psychiatric inpatient claims, reconcile claims with tariff service scopes and calculate patient co-payments, resolve disputes with hospitals and explain results to stakeholders, contribute to the development of billing rules and audit tools
Seniority
Mid-level specialist
