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 tot his job Apply To this Job