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

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

Job summary

Gap Solution Recurrent Firm is seeking an experienced Registered Nurse (PHRN) with a DRG clinical appeals background to join our Healthcare BPO team. The role involves reviewing inpatient records, evaluating documentation, and drafting appeal letters to support accurate reimbursement.

Candidates should have an active PHRN license, at least 1 year of DRG clinical appeals experience, and strong English communication. Night shift work is required, and work-from-home setup applies in the Philippines.

Qualifications

• Active Philippine Registered Nurse license
• Minimum 1 year DRG Clinical Appeals experience in healthcare BPO
• Clinical Appeals writing experience
• Experience with DRG downcoding
• Familiarity with MS-DRG and/or APR-DRG
• Experience using MCG and/or InterQual guidelines
• Familiarity with ICD-10-CM/PCS coding guidelines
• Strong analytical and documentation review skills
• Excellent written and verbal English communication
• Willing to work Night Shift

Responsibilities

• Review inpatient medical records and evaluate clinical documentation
• Prepare clinical appeal letters for DRG disputes
• Support accurate reimbursement using DRG guidelines
• Maintain high accuracy and regulatory compliance

Skills

Clinical documentation

Analytical thinking

English communication

DRG knowledge

Education

PHRN License

Tools

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

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.