LPN - Notice Of Action Letter Auditor

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary:

This position is 100% remote.
Letter Team operating hours are 7am-7:30pm Est. Sunday availability is required. Variations of working hours will be discussed during interview.
No travel is required.
Applicants from any state can apply.

Job Description:

Utilizes clinical and critical thinking skills to complete notice of action (NOA) letters members and providers for approved or denied services. Requires LPN/LVN with unrestricted active license.

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. We work closely with the utilization management team.

Required Qualifications:

- 1 year of outpatient clinical experience required

- LPN/LVN with current unrestricted licensure required

Preferred Qualifications:

- 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

Education:

Licensed Practical/ Vocational Nurse diploma/ Associate Degree

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.