PHRN Clinical Appeals DRG Specialist - 1 Year DRG Appeals Exp BPO

Registered Nurse (PHRN) | Clinical Appeals DRG Specialist | 1+ Year Clinical Appeals DRG Experience | Work From Home | ₱70K–₱85K

Salary Package: ₱70,000–₱85,000 (Depending on your skills, qualifications, relevant experience, and interview results.)

Work Setup: Work From Home

Work Location: Quezon City | Taguig City | Cebu City

Shift: Night Shift

We are seeking experienced Registered Nurses (PHRN) with a strong background in Clinical Appeals DRG to join our Healthcare BPO team. This role involves reviewing inpatient medical records, evaluating clinical documentation, preparing clinical appeal letters, and supporting accurate reimbursement using industry-standard clinical guidelines.

Active Philippine Registered Nurse (PHRN) License

Minimum of 1 year of Clinical Appeals DRG experience in a Healthcare BPO

Clinical Appeals Writing experience

Experience with DRG Downcoding

Knowledge of MS-DRG and/or APR-DRG

Experience using MCG and/or InterQual Guidelines

Familiarity with ICD-10-CM/PCS Coding Guidelines

Strong analytical, documentation review, and clinical decision-making skills

Excellent written and verbal English communication skills

Willing to work Night Shift

Important – Please Read Before Applying

Your application will undergo an initial resume paper screening.

Applications will be automatically rejected if your resume does not clearly demonstrate:

At least 1 year of Clinical Appeals DRG experience in a Healthcare BPO

Clinical Appeals Writing experience

DRG Downcoding experience

If your Clinical Appeals DRG experience is not clearly reflected in your work history, your application will not proceed to the next stage. Please update your resume before submitting your application.