Remote RN: Clinical Appeals DRG Specialist – Night Shift

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

Job summary

Gap Solution Recurrent Firm is seeking an experienced Registered Nurse (PHRN) with a DRG clinical appeals background to join our Healthcare BPO team. The role involves reviewing inpatient records, evaluating documentation, and drafting appeal letters to support accurate reimbursement.

Candidates should have an active PHRN license, at least 1 year of DRG clinical appeals experience, and strong English communication. Night shift work is required, and work-from-home setup applies in the Philippines.

Qualifications

• Active Philippine Registered Nurse license
• Minimum 1 year DRG Clinical Appeals experience in healthcare BPO
• Clinical Appeals writing experience
• Experience with DRG downcoding
• Familiarity with MS-DRG and/or APR-DRG
• Experience using MCG and/or InterQual guidelines
• Familiarity with ICD-10-CM/PCS coding guidelines
• Strong analytical and documentation review skills
• Excellent written and verbal English communication
• Willing to work Night Shift

Responsibilities

• Review inpatient medical records and evaluate clinical documentation
• Prepare clinical appeal letters for DRG disputes
• Support accurate reimbursement using DRG guidelines
• Maintain high accuracy and regulatory compliance

Skills

Clinical documentation

Analytical thinking

English communication

DRG knowledge

Education

PHRN License

Tools

MCG guidelines

InterQual guidelines

ICD-10-CM/PCS

Job description

Gap Solution Recurrent Firm is seeking an experienced Registered Nurse (PHRN) with a DRG clinical appeals background to join our Healthcare BPO team. The role involves reviewing inpatient records, evaluating documentation, and drafting appeal letters to support accurate reimbursement.

Candidates should have an active PHRN license, at least 1 year of DRG clinical appeals experience, and strong English communication. Night shift work is required, and work-from-home setup applies in the Philippines.