Job Description
- 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