Phrn Clinical Appeals Drg Specialist - 1 Year Drg Appeals Exp Bpo

Epsilon Group Services; Cauayan; Remote; PHP 781,000 - 949,000; Full time

Job summary

Epsilon Group Services is seeking an experienced Registered Nurse (PHRN) with a strong Clinical Appeals DRG background to join our Healthcare BPO team in a remote, night-shift role. You will review inpatient records, evaluate documentation, and draft clinical appeal letters to aid accurate reimbursement under DRG guidelines.

Active PHRN license and at least 1 year in DRG appeals are required, with proficiency in ICD-10-CM/PCS and MS-DRG/APR-DRG, InterQual/MCG guidelines.

Qualifications

• Active Philippine Registered Nurse 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.

Responsibilities

• Review inpatient medical records for DRG clinical appeals.
• Evaluate clinical documentation to support accurate reimbursement.
• Prepare clinical appeal letters and supporting documentation.
• Collaborate with healthcare professionals to ensure compliant coding and documentation.

Skills

Clinical DRG

DRG Writing

Analytical skills

English communication

Night shift

Education

PHRN license

Tools

MS-DRG knowledge

APR-DRG knowledge

MCG guidelines

InterQual guidelines

ICD-10-CM/PCS

Job description

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

About the Role

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.

Non-Negotiable Requirements

• 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