Revenue Cycle Negotiator

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 was founded to make a difference. Our philosophy is simple: to improve the quality of life of every patient we treat. And our vision is clear: Deliver exceptional orthopedic care with compassion and ensure each step towards recovery is met with understanding and personalized care.

The Negotiator is responsible for reviewing and negotiating low and high dollar medical, surgical, and facility claims using FAIR Health guidelines to determine appropriate settlement amounts. The Negotiator actively communicates with insurance carriers and third-party representatives to make, accept, counter, or elevate negotiation offers in accordance with departmental standards. Additionally, the role requires maintaining detailed negotiation tracking records, verifying final payments with AR and Payment Posting teams, and reporting reimbursement trends to Billing Management.

Duties

• Review patient insurance benefits and coverage information before creating claims.
• Monitor benefit limitations, including the number of allowed Occupational Therapy (OT), Physical Therapy (PT), and Acupuncture visits.
• Update the EMR system with benefit information and document when patients have reached or are approaching their maximum allowed visits.
• Create and prepare medical claims for services provided at NexGen.
• Review clinical notes and documentation to ensure they are complete and support the services being billed.
• Enter the appropriate CPT codes, diagnosis information, and required modifiers on each claim.
• Verify that all claim information is accurate before submission.
• Submit completed claims to the appropriate insurance company in a timely manner.
• Identify missing or inaccurate information and communicate with the appropriate team member when corrections are needed.
• Follow NexGen billing procedures and insurance requirements to help reduce claim errors and denials.
• Maintain accurate documentation and updates within the EMR system.
• Communicate with the Billing Team Lead, Billing Manager, and management regarding claim issues, benefit limitations, or documentation concerns.
• Assist with claim corrections or resubmissions when necessary.
• Review Month end Unbilled Claims Reports.

Pay Range: $24 to $28.50/hr.

Job Type: Full Time

EEO STATEMENT

NexGen Orthopedic Health & Wellness is an equal employment opportunity employer and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.