PHRN Appeals DRG Specialist | MUST HAVE Appeals DRG BPO Exp | WFH

PHRN Appeals DRG Specialist | MUST HAVE Appeals DRG BPO Experience | Clinical Appeals Writing | WFH After Onsite Training

Work Location: Quezon City / Taguig City / Cebu City

Work Setup: WFH after successful completion of onsite training

Training Setup: Onsite

Start Date: January 2027

Openings: 31

Salary Package: ₱70,000–₱85,000

Educational Attainment: College Graduate of BS Nursing

SOB: Requires Business Approval

Must be currently residing in NCR or Cebu — STRICT REQUIREMENT

MUST HAVE Appeals DRG experience in a BPO/Healthcare BPO setting

6 months to 1+ year of Clinical Appeals Writing experience — REQUIRED

Experience writing clinical appeals for healthcare insurance denials

Experience with DRG downcoding or coding appeals

Familiarity with MCG and/or InterQual guidelines

Familiarity with ICD-10 coding guidelines

Experience in Medical Coding, CDI, or DRG Downcoding

Strong knowledge of medical necessity criteria

BS Nursing graduate

Strong clinical documentation and medical writing skills

Strong attention to detail and analytical skills

Willing to undergo mandatory onsite training

Must be willing to transition to WFH after successful completion of training

We are looking for experienced PHRN Appeals DRG Specialists with strong Appeals DRG BPO experience and clinical appeals writing expertise.

The role involves reviewing clinical documentation, identifying the basis of denials, and preparing well-supported appeal letters for healthcare insurance cases.

Candidates must have experience in:

Appeals DRG in a BPO/Healthcare BPO environment

Clinical Appeals Writing

DRG Downcoding

Coding Appeals

Medical Coding or CDI

Healthcare Insurance Appeals

Experience with both MS-DRG and APR-DRG is preferred.

Mandatory Onsite Training → WFH After Successful Training

Training will be conducted onsite in:

Quezon City

Taguig City

Cebu City

Residency Requirement:

Candidates must be currently residing in NCR or Cebu and must be willing to report onsite for the required training.

After successful completion of training and performance requirements, the position will transition to Work From Home.