Substantiation Analyst
Nonstop Administration & Insurance Services
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $29 per hour
Job Level
JuniorMid-Level
About the role
- Resolve substantiation tickets promptly with professionalism and clarity, providing high-level customer service through written and verbal communication
- Maintain accurate, thorough case notes and escalate issues to leadership when appropriate
- Work effectively in a fast-paced, remote work environment with high-volume ticket traffic
- Demonstrate expert understanding of healthcare coverage, including in-network and out-of-network services, provider eligibility, and service classifications
- Review and explain Explanation of Benefits (EOBs), provider billing statements, and other medical documentation
- Occasionally coordinate with medical carriers and provider billing departments to resolve claim discrepancies
- De-escalate difficult member situations by offering calm, empathetic, and solutions-focused support
- Ensure all interactions reflect a commitment to member satisfaction and positive outcomes
- Build trust and foster positive relationships by going above and beyond for members
- Adhere strictly to HIPAA and confidentiality policies, as well as internal processes and compliance standards
- Engage in ongoing training and professional development to stay current on healthcare trends and substantiation best practices
Requirements
- 2+ years of experience in healthcare claims, substantiation, insurance, or medical billing preferred
- Strong knowledge of EOBs, medical terminology, and insurance processes
- Strong attention to detail and accuracy in documentation
- Proven ability to manage multiple tasks and meet deadlines in a high-volume environment
- Experience working with sensitive health information in accordance with HIPAA
- Commitment to high-quality customer service and member advocacy
- Tech-savvy with the ability to learn and navigate internal systems and ticketing tools
- Strong communication skills—verbal and written
- Ability to work independently and in a collaborative, remote environment
- Problem-solving and critical thinking skills
Benefits
- Health, fully covered: 100% of medical, dental, and vision premiums for you and your dependents
- Fully remote position
- Technology allowance
- Flexible PTO and holidays
- Financial wellness: 401(k) match
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
healthcare claimssubstantiationmedical billingEOBsmedical terminologyinsurance processesdocumentation accuracyHIPAA complianceproblem-solvingcritical thinking
Soft skills
customer servicemember advocacyattention to detailcommunicationempathyrelationship buildingindependencecollaborationtime managementprofessionalism