Senior Grievance & Appeals Architect

CareSource; Dayton (OH); Hybrid; USD 32,000 - 51,000; Full time

Job summary

CareSource in Dayton, OH is seeking a Grievance & Appeals Specialist III to process and respond to claim appeals, disputes, and provide subject matter expertise in coding denials. You will collaborate with leadership to ensure accurate, timely decisions and compliance with state and federal requirements.

Position requires 3+ years in healthcare customer service or related fields, with preferred coding experience and CPC/RHIT/RHIA certification. General office environment with hourly compensation.

Qualifications

• High school diploma or equivalent required.
• Associates degree or equivalent experience preferred.
• At least 3 years in healthcare customer service, claims, compliance or related field; coding experience included.

Responsibilities

• Process and respond to claim appeals and disputes.
• Prepare appeals for clinical review and document outcomes.
• Review appeals for validity and ensure timely processing within regulatory timeframes.
• Collaborate with Medical Management, Provider Operations and Claims teams.

Skills

Strong written communication

Attention to detail

Time management

Critical thinking

Education

High school diploma

Associates degree

Tools

Microsoft Word

Excel

Access

Job description

CareSource in Dayton, OH is seeking a Grievance & Appeals Specialist III to process and respond to claim appeals, disputes, and provide subject matter expertise in coding denials. You will collaborate with leadership to ensure accurate, timely decisions and compliance with state and federal requirements.

Position requires 3+ years in healthcare customer service or related fields, with preferred coding experience and CPC/RHIT/RHIA certification. General office environment with hourly compensation.