PHRN DRG Appeals Specialist - WFH After Training

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

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.