Payment Integrity RN

. Audit providers to ensure correct medical coding and billing practices .

Posted 10/15/2026full-timeRemote • Louisiana • United StatesJuniorMid-LevelWebsite

Key responsibilities & impact

Audit providers to ensure correct medical coding and billing practices
Enforce reimbursement and member agreement compliance
Recover incorrect payments
Resolve CPT or ICD9 reimbursement and medical coding appeals and inquiries
Clarify coding issues, clinical editor bundling, medical coding policy, coding-related reimbursement, and medical policy issues
Identify provider reimbursement problems, including coding and processing issues
Research, audit, and recommend corrective action by providers or BCBSLA
Maintain understanding of coding guidelines, provider operations and billing systems, contract benefits, claims procedures, provider contracts, and reimbursement agreements
Engage in provider relations activities to resolve provider and subscriber problems and maintain a positive Plan image
Research excessive coding and charge patterns and overutilization of services to support contracting and reimbursement negotiations
Perform other job-related duties within the scope of responsibilities

What you’ll need

Bachelor's Degree in Nursing or RN Certification required
2 years of experience as an RN required
Residency in or relocation to Louisiana preferred
Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support
Current, unrestricted RN state licensure or compact-state RN licensure; RN licensed to practice in Louisiana required
Current, unrestricted RN license to practice in states other than Louisiana preferred
Ability to travel overnight, up to one week, in a personal vehicle
Thorough knowledge of disease processes and medical and surgical procedures
Excellent oral and written communication skills
Good analytical, organizational, and interpersonal skills
Working knowledge of Word and Excel and ability to learn new applications
Experience in a multispecialty setting preferred
Experience with provider billing practices, AMA coding guidelines, Correct Coding Initiative edits, physician specialty guidelines, BCBSLA reimbursement programs, provider agreements, claims adjudication processes, and regulatory agency policies preferred
Good research and audit skills and prior audit-related experience preferred
Medical coding background (ICD9 and CPT4) preferred
Certified Professional Coder (CPC) preferred
Any licensure restriction must not affect the health professional’s ability to fulfill reviewer responsibilities

Comp & perks