Medical Claims Negotiator (Revenue Cycle)

NexGen Orthopedic Health & Wellness; Paramus (NJ); On-site; USD 33,000 - 39,000; Full time

Job summary

NexGen Orthopedic Health and Wellness is seeking a Negotiator to review and negotiate low and high-dollar medical, surgical, and facility claims using FAIR Health guidelines to determine settlements. You will actively communicate with insurance carriers and third-party representatives to make, accept, counter, or elevate offers in line with departmental standards.

The role involves maintaining negotiation records, verifying final payments with AR and Posting teams, and reporting reimbursement

Qualifications

• Experience negotiating medical, surgical, and facility claims.

Responsibilities

• Review patient insurance benefits and coverage information before creating claims.
• Monitor benefit limitations for OT, PT, and Acupuncture visits.
• Update EMR with benefit information and visit caps.
• Create and prepare medical claims for NexGen services.
• Review clinical notes to ensure documentation supports billing.
• Enter CPT codes, diagnosis information, and modifiers on claims.
• Verify accuracy of claim information before submission.
• Submit claims to insurers promptly.
• Identify missing or inaccurate information and coordinate with the team.
• Follow NexGen billing procedures to reduce errors and denials.
• Maintain documentation in EMR.
• Communicate with Billing leads about issues.
• Assist with claim corrections or resubmissions.
• Review Month end Unbilled Claims Reports.

Job description

NexGen Orthopedic Health and Wellness is seeking a Negotiator to review and negotiate low and high-dollar medical, surgical, and facility claims using FAIR Health guidelines to determine settlements. You will actively communicate with insurance carriers and third-party representatives to make, accept, counter, or elevate offers in line with departmental standards.

The role involves maintaining negotiation records, verifying final payments with AR and Posting teams, and reporting reimbursement