LPN – Notice Of Action Letter Auditor

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🔥 0 minutes ago

🐊 Florida, Illinois, +4 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $22 - $48 / hour

⏰ Full Time

🟢 Junior

🔎 Auditor

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Utilize clinical and critical thinking skills to complete notice of action (NOA) letters for members and providers for approved or denied services • Write and audit notice of action letters • Collect information to support appropriate, member-friendly notice of action letters • Apply clinical experience, criteria/guidelines, policies, and procedures to ensure letters are timely and accurate • Promote and support quality effectiveness of Healthcare Services and benefit utilization • Work closely with the utilization management team • No travel required

🎯 Requirements

• LPN/LVN with current unrestricted licensure required • 1 year of outpatient clinical experience required • Licensed Practical/Vocational Nurse diploma or Associate Degree • Sunday availability required • Ability to work within Letter Team operating hours of 7am–7:30pm EST • 2 years managed care experience preferred • 2 years prior authorization experience preferred • Prior experience using Quadient and/or MedCompass preferred • Knowledge of Medicare/Medicaid preferred • Exceptional attention to detail preferred • Strong grammar, proofreading, and writing skills preferred • Critical thinking and analytical abilities preferred • Ability to interpret clinical documentation and guidelines preferred • Strong judgment and decision-making skills preferred • Auditing and quality review experience preferred • Ability to prioritize and meet deadlines preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility