Substantiation Analyst
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Job Description
Substantiation Analyst role with Nonstop Administration handling healthcare claims and providing exceptional member service. Involves reviewing documentation and ensuring compliance with healthcare regulations.
Responsibilities:
- 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
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