Remote PHRN: Clinical Appeals DRG Specialist Night Shift

Recruitify_HR; Cebu City; Remote; PHP 781,200 - 948,600; Full time

Job summary

Recruitify_HR is seeking an experienced Registered Nurse (PHRN) with Clinical Appeals DRG expertise to join our Healthcare BPO team. Review inpatient records, evaluate documentation, and prepare appeal letters to support appropriate reimbursement.

The role requires DRG experience, strong English communication, and willingness to work Night Shift; remote work setup from multiple Philippine locations including Cebu City.

Qualifications

• Active Philippine Registered Nurse (PHRN) License required.
• Minimum of 1 year Clinical Appeals DRG experience in Healthcare BPO.
• Clinical Appeals Writing experience and DRG downcoding knowledge.

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 (MCG/InterQual).
• Analyze payer denials related to DRG assignment and reimbursement.
• Validate diagnoses and DRG assignments using ICD-10 guidelines.
• Collaborate with coding and clinical teams to maximize reimbursement outcomes.
• Meet quality, accuracy, and productivity standards.

Skills

English communication

Analytical skills

Clinical decision-making

Night shift

Education

PHRN License

Job description

Recruitify_HR is seeking an experienced Registered Nurse (PHRN) with Clinical Appeals DRG expertise to join our Healthcare BPO team. Review inpatient records, evaluate documentation, and prepare appeal letters to support appropriate reimbursement.

The role requires DRG experience, strong English communication, and willingness to work Night Shift; remote work setup from multiple Philippine locations including Cebu City.