Priority Health · 18 hours ago
Claim Edit Coding Analyst
Grand Rapids, MI
Full-time
Onsite
Entry Level
2+ years expPriority Health is a nationally recognized health system committed to delivering personalized health care. The Claim Edit Coding Analyst will apply analytical and technical skills to develop solutions that prevent overpayments and enhance claims payment accuracy while coordinating with vendors and other departments.
HealthcareHealth Care
Responsibilities
Coordinate with vendors to review findings and identify methods to increase claims payment accuracy and integrity
Ability to manage and resolve conflicting points of view from providers and internal departments (includes appeals to health plan for Payment Integrity initiatives)
Analyze results of ongoing leakage and prevention monitoring to identify inefficiencies and improve solution effectiveness
Coordinate and support activities related to vendor contracts. Manage proper controls for vendor invoicing, validation, reconciliations and adjustments. Prepare check requests for vendor payments
Coordinate with other departments as needed to accomplish cross–departmental projects and/or goals
Analyze and review initial, subsequent and or final filings to ensure submissions received are covered and eligibility requirements are satisfied per the groups stop loss policy (SPD, stop loss policy, fee disclosure)
Examine claims for stop loss eligibility including verifying stop loss coverage, eligibility (knowledge of plan eligibility requirements including FMLA, MLOA, COBRA)
Qualification
Required
Associate's degree or equivalent preferably in a health or business-related degree
2 years of relevant experience Health plan operations experience to include end to end claims operations and processes
Experience with root cause analysis
Preferred
Bachelor's Degree preferably in a health or business-related degree
CRT-Professional Coder - AAPC American Academy of Professional Coders Upon Hire
CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association Upon Hire
CRT-Coding Specialist, Certified-Physician Based (CCS-P) - AHIMA American Health Information Management Association Upon Hire
CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association Upon Hire
CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders Upon Hire
Benefits
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Company
Priority Health
Priority Health is an award-winning health benefits company.
1001-5000 employees
H1B Sponsorship
Priority Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (6)
2024 (9)
2023 (9)
2022 (10)
2021 (5)
2020 (8)
Funding
Current Stage
Late StageTotal Funding
$0.5MKey Investors
Michigan Health Endowment Fund
2022-02-24Grant· $0.5M
Leadership Team
Nick Gates
President
Recent News
2025-12-11
Morningstar.com
2025-11-18
Company data provided by crunchbase