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

Ggas Services; Philippines; Remote; PHP 781,000 - 949,000; Full time

Benefits offered by this job

Work From Home

Job summary

Ggas Services is seeking an experienced Registered Nurse (PHRN) with a strong Clinical Appeals DRG background to join our Healthcare BPO team. You will review inpatient records, evaluate documentation, and prepare appeal letters to support appropriate reimbursement.

Ideal candidates have an active PHRN license, 1+ year DRG experience in a BPO, and strong English communication. Night shift work and remote setup are available in the Philippines.

Qualifications

• 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.

Responsibilities

• Review inpatient medical records.
• Evaluate clinical documentation for accuracy and completeness.
• Prepare clinical appeal letters to support reimbursement.
• Support accurate reimbursement using industry guidelines.

Skills

DRG knowledge

DRG downcoding

MS-DRG/APR-DRG

ICD-10-CM/PCS

clinical documentation

English communication

Tools

MCG guidelines

InterQual guidelines

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.

• 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