Remote Night-Shift PHRN Clinical Appeals DRG Specialist

Epsilon Group Services; Cauayan; Remote; PHP 781,000 - 949,000; Full time

Job summary

Epsilon Group Services is seeking an experienced Registered Nurse (PHRN) with a strong Clinical Appeals DRG background to join our Healthcare BPO team in a remote, night-shift role. You will review inpatient records, evaluate documentation, and draft clinical appeal letters to aid accurate reimbursement under DRG guidelines.

Active PHRN license and at least 1 year in DRG appeals are required, with proficiency in ICD-10-CM/PCS and MS-DRG/APR-DRG, InterQual/MCG guidelines.

Qualifications

• Active Philippine Registered Nurse 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 for DRG clinical appeals.
• Evaluate clinical documentation to support accurate reimbursement.
• Prepare clinical appeal letters and supporting documentation.
• Collaborate with healthcare professionals to ensure compliant coding and documentation.

Skills

Clinical DRG

DRG Writing

Analytical skills

English communication

Night shift

Education

PHRN license

Tools

MS-DRG knowledge

APR-DRG knowledge

MCG guidelines

InterQual guidelines

ICD-10-CM/PCS

Job description

Epsilon Group Services is seeking an experienced Registered Nurse (PHRN) with a strong Clinical Appeals DRG background to join our Healthcare BPO team in a remote, night-shift role. You will review inpatient records, evaluate documentation, and draft clinical appeal letters to aid accurate reimbursement under DRG guidelines.

Active PHRN license and at least 1 year in DRG appeals are required, with proficiency in ICD-10-CM/PCS and MS-DRG/APR-DRG, InterQual/MCG guidelines.