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CVS Health

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Clinical Auditor, Notice of Action

AuditorAuditorFull TimeRemoteMid LevelTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Arizona + 4 moreAll locations: Arizona, California, Nevada, Oregon, Washington

Posted

24 days ago

Salary

$22 - $53 / hour

Seniority

Mid Level

Associate Degree2 yrs expEnglish

Job Description

• 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.

Job 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.

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