RN Payment Integrity Auditor: Billing & Coding Expert

Bcbsla; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

BCBSLA is seeking a Nurse Auditor to ensure accurate medical coding, billing practices, and compliance with reimbursement rules. The role requires RN licensure and at least 2 years of clinical experience, with familiarity of CMS/DOI regulations and coding guidelines. Travel may be required.

The position reports to the Manager, Payment Integrity, Clinical, and involves collaboration with providers, physicians, and internal teams in a busy health plan environment in Louisiana.

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.

Responsibilities

• Audit providers to ensure correct medical coding and billing practices.
• Resolve CPT/ICD9 reimbursement and coding inquiries for internal and external requests.
• Identify provider reimbursement problems and recommend corrective action.
• Maintain understanding of coding guidelines and billing systems.
• Travel overnight up to one week as needed.

Skills

Disease processes knowledge

Audit skills

Communication skills

Analytical skills

Travel readiness

Word/Excel proficiency

Education

Bachelor’s Degree in Nursing

RN Licensure (Louisiana)

Compact State Licensure

Tools

Word

Excel

Job description

BCBSLA is seeking a Nurse Auditor to ensure accurate medical coding, billing practices, and compliance with reimbursement rules. The role requires RN licensure and at least 2 years of clinical experience, with familiarity of CMS/DOI regulations and coding guidelines. Travel may be required.

The position reports to the Manager, Payment Integrity, Clinical, and involves collaboration with providers, physicians, and internal teams in a busy health plan environment in Louisiana.