Job description
Remote: Remote
PHRN Appeals DRG Specialist | MUST HAVE Appeals DRG BPO Experience | Clinical Appeals Writing | WFH After Onsite Training
Work Location: Quezon City / Taguig City / Cebu City
Work Setup: WFH after successful completion of onsite training
Training Setup: Onsite
Start Date: January 2027
Openings: 31
Salary Package: ₱70,000--₱85,000
Educational Attainment: College Graduate of BS Nursing
SOB: Requires Business Approval
STRICT REQUIREMENTS
Must be currently residing in NCR or Cebu --- STRICT REQUIREMENT
MUST HAVE Appeals DRG experience in a BPO/Healthcare BPO setting
6 months to 1+ year of Clinical Appeals Writing experience --- REQUIRED
Experience writing clinical appeals for healthcare insurance denials
Experience with DRG downcoding or coding appeals
Familiarity with MCG and/or InterQual guidelines
Familiarity with ICD-10 coding guidelines
Experience in Medical Coding, CDI, or DRG Downcoding
Strong knowledge of medical necessity criteria
BS Nursing graduate
Strong clinical documentation and medical writing skills
Strong attention to detail and analytical skills
Willing to undergo mandatory onsite training
Must be willing to transition to WFH after successful completion of training
ABOUT THE ROLE
We are looking for experienced PHRN Appeals DRG Specialists with strong Appeals DRG BPO experience and clinical appeals writing expertise.
The role involves reviewing clinical documentation, identifying the basis of denials, and preparing well-supported appeal letters for healthcare insurance cases.
REQUIRED EXPERIENCE
Candidates must have experience in:
Appeals DRG in a BPO/Healthcare BPO environment
Clinical Appeals Writing
DRG Downcoding
Coding Appeals
Medical Coding or CDI
Healthcare Insurance Appeals
Experience with both MS-DRG and APR-DRG is preferred.
WORK SETUP
Mandatory Onsite Training → WFH After Successful Training
Training will be conducted onsite in:
Quezon City
Taguig City
Cebu City
Residency Requirement:
Candidates must be currently residing in NCR or Cebu and must be willing to report onsite for the required training.
After successful completion of training and performance requirements, the position will transition to Work From Home.
SALARY
₱70,000--₱85,000 Salary Package
