Payment Integrity RN

Job not on LinkedIn

🔥 42 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross Blue Shield Association, offering a range of health insurance products and services in the state of Louisiana. The company provides health, dental, and travel insurance options, including Medicare Advantage plans such as HMO and PPO. They focus on delivering comprehensive healthcare coverage through various plans to meet varying customer needs, while partnering with doctors, hospitals, and clinics to ensure quality care and support. Additionally, the company emphasizes wellness programs, cost-saving opportunities, and accessibility for its members.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• Resources to live well and be healthy • Continued learning and skill development • Professional growth opportunities • Opportunities to serve local communities • Reasonable accommodations for individuals with disabilities • Smoke- and tobacco-free workplace • Background and pre-employment drug screening