Remote DRG Appeals Specialist (PHRN) – BPO Healthcare

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

Benefits offered by this job

Onsite Training

WFH after Training

Job summary

Gap Solution Recurrent Firm is seeking a PHRN Appeals DRG Specialist with DRG Appeals BPO experience and clinical appeals writing expertise.

The role reviews clinical documentation, identifies denial bases, and writes persuasive appeal letters for healthcare insurance cases. Training is onsite, with a transition to Work From Home after successful completion. Start date January 2027; salary ₱70,000–₱85,000 monthly.

Qualifications

• Must have DRG Appeals experience in a Healthcare BPO setting.
• Clinical Appeals Writing experience required (6 months to 1+ year).
• Experience with medical coding or CDI and ICD-10 guidelines.
• Knowledge of DRG downcoding and coding appeals.
• Familiarity with MCG and InterQual guidelines is preferred.
• Willing to undergo onsite training and transition to WFH after training.

Responsibilities

• Review clinical documentation to identify denial bases.
• Prepare well-supported appeal letters for healthcare insurance cases.
• Collaborate with healthcare teams to improve documentation quality.
• Ensure compliance with DRG and coding guidelines during appeals.

Skills

DRG Appeals Experience

Clinical Appeals Writing

Medical Coding

ICD-10 Knowledge

DRG Downcoding

MCG/InterQual Familiarity

Education

BS Nursing

Job description

Gap Solution Recurrent Firm is seeking a PHRN Appeals DRG Specialist with DRG Appeals BPO experience and clinical appeals writing expertise.

The role reviews clinical documentation, identifies denial bases, and writes persuasive appeal letters for healthcare insurance cases. Training is onsite, with a transition to Work From Home after successful completion. Start date January 2027; salary ₱70,000–₱85,000 monthly.