Clinical Auditor, Notice of Action
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Arizona • California • United States
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Salary
💰 $22 - $54 per hour
About the role
- Audit NOA letters for compliance with AHCCCS (Arizona Health Care Cost Containment System), CMS (Centers for Medicare & Medicaid Services), and other regulatory standards.
- Ensure letters are easy to understand, free of spelling/grammar errors, and clinically accurate.
- Review and validate clinical definitions and terminology used in letters.
- Audit requests across multiple service types: pharmacy, medical, dental, and behavioral health.
- Provide feedback to letter writers and team leads to support quality improvement.
- Track audit results and identify trends or recurring issues.
- Collaborate with QA (quality assurance) and Training teams to refine audit tools and update training materials.
- Participate in calibration sessions to ensure consistency in audit standards.
- Stay current with changes in clinical guidelines and regulatory requirements.
- Assist in completing NOA letters and faxes when needed due to volume.
- Help translate complex medical language into member-friendly terms.
Requirements
- Active or unrestricted LPN licensure in the state of residence.
- Must reside in Arizona, California, Washington, Oregon, or Nevada.
- 2+ years of experience in healthcare.
- Minimum 1 year of experience navigating internal/external computer systems, including an ability to interpret clinical documentation and apply policy guidelines.
- Demonstrated proficiency in Microsoft Suite, including spell and grammar check.
- Strong attention to detail and analytical skills.
- Excellent written and verbal communication skills.
- Experience with behavioral health or ABA services.
- Prior experience in a managed care or Medicaid/Medicare environment.
- Familiarity with QNXT or similar systems.
- Ability to explain complex medical concepts in plain language.
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
LPN licensureclinical documentation interpretationaudit compliancequality assurancemedical terminologyspell checkgrammar checkbehavioral health experiencemanaged care experienceQNXT familiarity
Soft Skills
attention to detailanalytical skillswritten communicationverbal communicationcollaborationfeedback provisiontraining material developmenttrend identificationcomplex concept explanationquality improvement support
Certifications
active LPN licensure