LPN - Notice Of Action Letter Auditor
About The Position
This position is 100% remote. The Letter Team operating hours are 7am-7:30pm Est. Sunday availability is required. Variations of working hours will be discussed during the interview. No travel is required. Applicants from any state can apply. The role utilizes clinical and critical thinking skills to complete notice of action (NOA) letters for members and providers for approved or denied services. It requires an LPN/LVN with an unrestricted active license. The position promotes/supports quality effectiveness of Healthcare Services and benefit utilization. It utilizes clinical and critical thinking skills to write and audit notice of action letters to members and providers for approved or denied services. Information is collected to support the process of rendering appropriate, member-friendly, notice of action letters. Clinical experience, criteria/guidelines, policies, and procedures are utilized in support of ensuring that letters are timely and accurate. This role works closely with the utilization management team.
Requirements
- 1 year of outpatient clinical experience required
- LPN/LVN with current unrestricted licensure required
Nice To Haves
- 2 years managed care experience
- 2 years prior authorization experience
- Prior experience using Quadient and/or MedCompass
- Knowledge of Medicare/Medicaid
- Exceptional attention to detail
- Strong grammar, proofreading, and writing skills
- Critical thinking and analytical abilities
- Ability to interpret clinical documentation and guidelines
- Strong judgment and decision-making skills
- Auditing and quality review experience
- Ability to prioritize and meet deadlines
Responsibilities
- Utilizes clinical and critical thinking skills to complete notice of action (NOA) letters members and providers for approved or denied services.
- Promotes/supports quality effectiveness of Healthcare Services and benefit utilization.
- Utilizes clinical and critical thinking skills to write and audit notice of action letters to members and providers for approved or denied services.
- Collects information to support the process of rendering appropriate, member friendly, notice of action letters.
- Utilizes clinical experience, criteria/guidelines, policies, and procedures in support of ensuring that letters are timely and accurate.
- Works closely with the utilization management team.
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
- CVS Health bonus
- commission
- short-term incentive program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
