Remote DRG Appeals Nurse (PHRN) – Night Shift

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

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.