Clinical Auditor, Notice of Action
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.
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.
Apply Now
Apply Now
• 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.
Apply Now
Apply Now