Phrn Appeals Drg Specialist | Must Have Appeals Drg Bpo Exp | Wfh

Gap Solution Recurrent Firm; Philippines; Hybrid; PHP 781,000 - 949,000; Full time

Job summary

Gap Solution Recurrent Firm seeks an experienced PHRN Appeals DRG Specialist to join a healthcare BPO team in the Philippines. After onsite training, the role transitions to work-from-home, focusing on robust DRG-based appeal letters for insurance denials and clear documentation of medical necessity.

The ideal candidate has DRG/Appeals experience in a healthcare BPO, strong clinical documentation, and familiarity with ICD-10, MCG and InterQual guidelines.

Qualifications

• Must have Appeals DRG experience in a BPO/Healthcare BPO setting.
• 6 months to 1+ year of Clinical Appeals Writing experience.
• Experience writing clinical appeals for healthcare insurance denials.
• Experience with DRG downcoding, coding appeals.
• Familiar with MCG and/or InterQual guidelines.
• Familiar with ICD-10 coding guidelines.
• BS Nursing graduate.
• Strong medical writing and documentation skills.
• Willing to undergo onsite training and transition to WFH.
• Must be currently residing in NCR or Cebu.

Responsibilities

• Review clinical documentation to identify the basis of denials and prepare well-supported appeal letters.
• Draft and submit DRG-based appeals for healthcare insurance cases.
• Ensure accuracy and compliance with DRG guidelines and coding standards.

Skills

Clinical Appeals Writing

Appeals DRG experience

Medical Coding

DRG Downcoding

ICD-10 coding

MCG familiarity

InterQual familiarity

Attention to detail

Analytical skills

BPO experience

Education

BS Nursing

Job description

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

STRICT REQUIREMENTS

• 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

ABOUT THE ROLE

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.

REQUIRED EXPERIENCE

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.

WORK SETUP

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.