Orthopedic Revenue Cycle Negotiator

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

Job summary

NexGen Orthopedic Health and Wellness in Paramus, NJ is seeking a Negotiator to review and negotiate medical, surgical, and facility claims using FAIR Health guidelines, determining settlements and communicating with carriers.

You will maintain negotiation tracking, verify final payments with AR and Payment Posting teams, and report reimbursement trends to Billing Management, while ensuring accuracy of CPT codes and documentation. This on-site role supports NexGen’s billing needs.

Qualifications

• Experience reviewing insurance benefits and determining settlements.
• Familiarity with FAIR Health guidelines for settlement ranges.
• Ability to communicate with insurance carriers and third parties.
• Accurate entry of CPT codes, diagnosis information, and modifiers.

Responsibilities

• Review insurance benefits before claims.
• Monitor benefit limits and visits for OT/PT/Acupuncture.
• Update EMR with benefit information and visit limits.
• Prepare medical claims for NexGen services.
• Review clinical notes to ensure support for billing.
• Enter CPT codes, diagnosis, and modifiers on claims.
• Verify accuracy before submission to insurers.
• Submit claims in a timely manner; communicate corrections needed.
• Follow NexGen billing procedures to reduce denials.
• Maintain documentation in the EMR system.
• Coordinate with Billing Team Lead/Manager on issues.
• Assist with claim corrections or resubmissions.
• Review Month end Unbilled Claims Reports.

Skills

Negotiation

Communication

Attention to detail

Medical billing knowledge

Tools

EMR system

Job description

NexGen Orthopedic Health and Wellness in Paramus, NJ is seeking a Negotiator to review and negotiate medical, surgical, and facility claims using FAIR Health guidelines, determining settlements and communicating with carriers.

You will maintain negotiation tracking, verify final payments with AR and Payment Posting teams, and report reimbursement trends to Billing Management, while ensuring accuracy of CPT codes and documentation. This on-site role supports NexGen’s billing needs.