PHRN Appeals DRG | DRG Downcoding & Coding Appeals Exp | WFH After Training

EPSILON GROUP SERVICES INC.; Cebu City; Hybrid; PHP 536,000 - 893,000; Full time

Job summary

EPSILON GROUP SERVICES INC. is seeking a PHRN Appeals DRG Specialist to review clinical documentation and craft appeal letters for DRG downcoding and coding-related matters. The role requires strong clinical review and precise appeal writing, backed by relevant coding guidelines.

The position starts with onsite training in Quezon City / Taguig City / Cebu City, then transitions to work-from-home. Competitive monthly salary up to ₱80,000 is offered, with start date on October 8, 2026 and 8

Qualifications

• Active PHRN License.
• Bachelor’s Degree in Nursing.
• 6 months to 1+ year Clinical Appeals Writing experience.
• Experience with DRG Downcoding and Coding Appeals.
• Experience using MC G / InterQual guidelines.
• Experience with ICD-10 coding guidelines.
• Experience using SOFA, KDIGO, GLIMS, and ASPEN criteria.
• Medical Coding, CDI, or DRG Downcode experience.
• Experience with MS-DRG and APR-DRG is preferred.
• Experience writing appeals for Medical Necessity Denials, Authorization Denials, DRG Downgrades, and Readmission cases.

Responsibilities

• Review clinical documentation and prepare appeal letters for DRG downcoding and coding-related appeals.
• Support appeals using appropriate clinical and coding guidelines.

Skills

Clinical Appeals Writing

DRG Downcoding

Coding Appeals

MCG / InterQual guidelines

ICD-10 guidelines

SOFA / KDIGO / GLIMS / ASPEN criteria

Medical Coding / CDI / DRG Downcode

MS-DRG / APR-DRG

Medical Necessity Denials appeals

Education

Bachelor’s Degree in Nursing

Job description

PHRN Appeals DRG | DRG Downcoding & Coding Appeals Experience | WFH After Training | Up to ₱80K

Work Location: Quezon City / Taguig City / Cebu City
Work Setup: Onsite Training, then Work From Home
Shift: 8:00 AM–5:00 PM
Salary: Up to ₱80,000, depending on your recruitment process experience
Start Date: October 8, 2026
Openings: 8

About the Role

The PHRN Appeals DRG Specialist will review clinical documentation and prepare appeal letters for DRG downcoding and coding-related appeals. The role requires strong clinical review and appeal writing skills, with the ability to support appeals using appropriate clinical and coding guidelines.

Qualifications

• Active PHRN License

• Bachelor’s Degree in Nursing

• 6 months to 1+ year Clinical Appeals Writing experience

• Experience with DRG Downcoding and Coding Appeals

• Experience using MCG / InterQual guidelines

• Experience with ICD-10 coding guidelines

• Experience using SOFA, KDIGO, GLIMS, and ASPEN criteria

• Medical Coding, CDI, or DRG Downcode experience

• Experience with MS-DRG and APR-DRG is preferred

• Experience writing appeals for Medical Necessity Denials, Authorization Denials, DRG Downgrades, and Readmission cases