Surgical Claims Specialist — On-Site & NSA Case Expert

NexGen Orthopedic Health & Wellness; Paramus (NJ); On-site; USD 33,000 - 37,000; Full time

Job summary

NexGen Orthopedic Health and Wellness in Paramus, NJ is seeking a Surgical Collections Representative to manage claims from operative reports through NSA arbitrations. This on-site, full-time role requires accurate CPT/diagnosis coding, claim follow-up, and collaboration with insurance carriers to secure timely reimbursement.

Responsibilities include reviewing EMR documentation, updating claim details, following up on denials, and documenting all activities.

Responsibilities

• Monitor 30, 60, 90 and 120+ day aging reports.
• Create surgical claims accurately using the appropriate CPT codes, diagnosis codes, modifiers, and supporting documentation.
• Review provider documentation and operative reports in the EMR to ensure all necessary information is complete and accurate before claim submission.
• Enter and update all required claim information in the EMR and place completed surgical claims in pending status for management review and approval.
• Follow up on surgical claims that are denied, unpaid, underpaid, incorrectly processed, or contain non-covered codes.
• Contact insurance companies to determine claim status, identify payment or denial issues, and work toward proper reimbursement based on the patient’s benefits and allowed amount.
• Monitor and follow up on all surgical and facility claims associated with Transcend Surgery Center.
• Document insurance follow-up, claim status, payment information, denials, and necessary next steps accurately in the EMR.
• Manage No Surprises Act (NSA) cases, including identifying applicable claims and preparing complete supporting packets for arbitration.
• Submit NSA/arbitration packets to the appropriate attorneys and continue following up on cases through resolution.
• Communicate claim issues, reimbursement concerns, documentation deficiencies, and cases requiring escalation to management.
• Maintain organized and accurate records of surgical claims and ensure outstanding accounts receive timely follow-up.

Job description

NexGen Orthopedic Health and Wellness in Paramus, NJ is seeking a Surgical Collections Representative to manage claims from operative reports through NSA arbitrations. This on-site, full-time role requires accurate CPT/diagnosis coding, claim follow-up, and collaboration with insurance carriers to secure timely reimbursement.

Responsibilities include reviewing EMR documentation, updating claim details, following up on denials, and documenting all activities.