[Hiring] NOA (Notice of Action) Letter Clinical Auditor @CVS Health

Role Description

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.

• 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.

Qualifications

• 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.

Requirements

• 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.

Education

• Associate’s degree in Practical Nursing and/or LPN vocational certification/diploma.

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.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.