Remote DRG Appeals Nurse Specialist | Night Shift

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

Job summary

Ggas Services is seeking an experienced Registered Nurse (PHRN) with a strong Clinical Appeals DRG background 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.

You will work from home on the night shift, collaborating with coding and clinical teams to maximize reimbursement outcomes.

Qualifications

• Active Philippine Registered Nurse (PHRN) license is required.
• Minimum of 1 year of Clinical Appeals DRG experience in a Healthcare BPO.
• Clinical Appeals writing experience required.
• Experience with DRG downcoding.
• Knowledge of MS-DRG and/or APR-DRG.
• Familiarity with ICD-10-CM/PCS coding guidelines.

Responsibilities

• Review inpatient medical records and supporting clinical documentation.
• Prepare evidence-based clinical appeal letters for denied or downcoded claims.
• Evaluate medical necessity using DRG guidelines.
• Analyze payer denials related to DRG assignment and reimbursement.
• Validate diagnoses, procedures, and DRG assignments using ICD-10 guidelines.
• Collaborate with coding and clinical teams to maximize reimbursement outcomes.
• Meet quality, accuracy, and productivity standards.

Skills

PHRN License

Clinical Appeals DRG

1+ year DRG experience

DRG Downcoding

MCG/APR-DRG knowledge

ICD-10-CM/PCS

English communication

Night Shift

Job description

Ggas Services is seeking an experienced Registered Nurse (PHRN) with a strong Clinical Appeals DRG background 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.

You will work from home on the night shift, collaborating with coding and clinical teams to maximize reimbursement outcomes.