Surgical Collections Representative

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 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 Surgical Collections Representative is responsible for reviewing operative reports, applying proper CPT and diagnosis codes, and creating accurate surgical and facility claims for management approval. The specialist monitors 30-120+ day aging reports and actively follows up with insurance carriers to resolve denied, underpaid, or incorrectly processed claims, including managing accounts associated with Transcend Surgery Center. Additionally, the role oversees No Surprises Act (NSA) cases by compiling arbitration packets, submitting them to legal counsel, and documenting all claim activities through final resolution.

Duties

• 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.

Work Location

100% In-Office / On-Site (Paramus, NJ) — No Remote/Hybrid Options Available

Pay Range

$24 to $27/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.