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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The NOA (Notice of Action) Letter Clinical Auditor is responsible for auditing NOA letters for both Medicare and Medicaid markets, in order to ensure compliance with regulatory guidelines, clinical accuracy, and clarity. This full-time telework role requires a detail-oriented professional who can assess letters for readability, grammar, spelling, and correct use of clinical definitions. The auditor will review requests across pharmacy, medical, dental, and behavioral health services. Based on volume, the auditor may also assist in completing letters and faxes.
Job Responsibility:
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
Associate’s degree in Practical Nursing and/or LPN vocational certification/diploma
Nice to have:
Strong attention to detail and analytical skills
Excellent written and verbal communication skills
Experience with behavioral health or ABA (Applied Behavior Analysis) 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
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost wellness screenings
No-cost tobacco cessation and weight management programs