RN, Payment Integrity Auditor

Louisiana Blue; Baton Rouge (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

Louisiana Blue seeks an RN with auditing expertise to ensure accurate medical coding and billing, enforce reimbursement rules, and recover incorrect payments. This role requires knowledge of CMS/HCFA guidelines and strong communication with providers and internal teams.

Residency in Louisiana preferred; applicants must be authorized to work in the United States without immigration sponsorship. Travel up to one week per trip is required; the work environment is office-based and collaborative with

Qualifications

• Bachelor’s Degree in Nursing or RN Certification required.
• 2 years of RN experience required.
• Experience with provider billing practices and coding guidelines preferred.
• Excellent oral and written communication skills.
• Willingness to travel overnight up to one week.
• Proficiency with Word and Excel.

Responsibilities

• Audit providers to ensure correct medical coding and billing practices.
• Resolve CPT/ICD9 reimbursement and coding inquiries.
• Identify provider reimbursement problems and recommend corrective actions.
• Maintain understanding of coding guidelines, contracts, and reimbursement agreements.
• Engage in provider relations to resolve issues.
• Investigate excessive coding and over-utilization to support negotiations.

Skills

RN experience

Audit skills

Communication skills

Analytical skills

Travel availability

Education

Bachelor's Degree in Nursing or RN Certification

Tools

Microsoft Word

Microsoft Excel

Job description

Louisiana Blue seeks an RN with auditing expertise to ensure accurate medical coding and billing, enforce reimbursement rules, and recover incorrect payments. This role requires knowledge of CMS/HCFA guidelines and strong communication with providers and internal teams.

Residency in Louisiana preferred; applicants must be authorized to work in the United States without immigration sponsorship. Travel up to one week per trip is required; the work environment is office-based and collaborative with