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Posted 29 days ago
Requirements and responsibilities
NOA Letter Clinical Auditor (Remote – Arizona Time)
Role Details
This is a fully remote position.
Candidates may reside anywhere in the U.S., but must work Monday–Friday, 8:00am–5:00pm (Arizona Time) with no exceptions.
The NOA Letter Clinical Auditor is responsible for auditing Medicare and Medicaid Notice of Action (NOA) letters for compliance, clarity, clinical accuracy, and proper use of terminology. The role supports pharmacy, medical, dental, and behavioral health reviews and may assist with letter completion based on volume.
Top 3 Required Skills
1. Clinical Competency & Policy Interpretation (Active LPN License Required)
Candidate must have an active, unrestricted LPN license in the state where they currently reside.
Key capabilities include:
* Understanding and interpreting clinical documentation.
* Verifying clinical definitions and medical terminology.
* Applying Medicare and Medicaid policies correctly.
This ensures the auditor can catch errors non‑clinical reviewers would miss.
2. Regulatory Compliance Auditing (AHCCCS, CMS, Medicaid/Medicare)
Experience must include reviewing for:
* CMS Medicare regulations.
* AHCCCS or other Medicaid program guidelines.
* Correct use of timeframes, definitions, and benefit determinations.
This role requires strong awareness of regulatory standards across multiple products.
3. Quality Assurance & Communication (Feedback + Accuracy Review)
Essential skills include:
* Reviewing letters for grammar, spelling, clarity, and member‑friendly language.
* Providing written feedback to letter writers and team leads.
* Identifying audit trends and supporting quality improvement initiatives.
This ensures consistent, high‑quality output and team alignment.
Duties
* Audit NOA letters for compliance with AHCCCS, CMS, 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 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.
Experience
Required Qualifications:
* Active or unrestricted LPN in the state of residence.
* Minimum 1 year of experience navigating internal/external computer systems.
* Proficiency in Microsoft Suite, including spell and grammar check.
* Strong attention to detail and analytical skills.
* Ability to interpret clinical documentation and apply policy guidelines.
* Excellent written and verbal communication skills.
Preferred Qualifications:
* 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.
Position Summary
The NOA (Notice of Action) Letter Clinical Auditor is responsible for auditing NOA letters for both Medicare and Medicaid markets 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.
Education
Active or unrestricted LPN in the state of residence.
Optionally, you can add more information later (benefits, pre-screening questions, etc.)