Corewell Health · 1 day ago
Claim Edit Coding Analyst
United States
Full-time
Remote
Entry Level
2+ years expCorewell Health is a nationally recognized health system committed to delivering personalized health care. The Claim Edit Coding Analyst plays a crucial role in preventing overpayments and enhancing claims payment accuracy by coordinating with vendors and analyzing claims processes.
HealthcareHospitalHealth CareMedical
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.
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
Corewell Health
Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Lynn Patterson
Sr. Executive Specialist To Chief Executive Officer
Karen Smith
Advisor to the Chief Financial Officer
Recent News
DBusiness Magazine
2026-02-05
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2026-01-06
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