Remote DRG Downcoding Nurse | Coding Appeals Expert

EPSILON GROUP SERVICES INC.

Cebu City

Hybrid

PHP 536,000 - 893,000

Full time

4 days ago

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Job summary

EPSILON GROUP SERVICES INC. is seeking a PHRN Appeals DRG Specialist to review clinical documentation and craft appeal letters for DRG downcoding and coding-related matters. The role requires strong clinical review and precise appeal writing, backed by relevant coding guidelines.

The position starts with onsite training in Quezon City / Taguig City / Cebu City, then transitions to work-from-home. Competitive monthly salary up to ₱80,000 is offered, with start date on October 8, 2026 and 8

Qualifications

Active PHRN License.
Bachelor’s Degree in Nursing.
6 months to 1+ year Clinical Appeals Writing experience.
Experience with DRG Downcoding and Coding Appeals.
Experience using MC G / InterQual guidelines.
Experience with ICD-10 coding guidelines.
Experience using SOFA, KDIGO, GLIMS, and ASPEN criteria.
Medical Coding, CDI, or DRG Downcode experience.
Experience with MS-DRG and APR-DRG is preferred.
Experience writing appeals for Medical Necessity Denials, Authorization Denials, DRG Downgrades, and Readmission cases.

Responsibilities

Review clinical documentation and prepare appeal letters for DRG downcoding and coding-related appeals.
Support appeals using appropriate clinical and coding guidelines.