PHRN Clinical Appeals DRG Specialist - 1 Year DRG Appeals Exp BPO

Registered Nurse (PHRN) | Clinical Appeals DRG Specialist | 1+ Year Clinical Appeals DRG Experience | Work From Home | ₱70K–₱85K Salary Package: ₱70,000–₱85,000 (Depending on your skills, qualifications, relevant experience, and interview results.) Work Setup: Work From Home Work Location: Quezon City | Taguig City | Cebu City Shift: Night Shift About the Role We are seeking experienced Registered Nurses (PHRN) with a strong background in Clinical Appeals DRG to join our Healthcare BPO team. This role involves reviewing inpatient medical records, evaluating clinical documentation, preparing clinical appeal letters, and supporting accurate reimbursement using industry-standard clinical guidelines. Non-Negotiable Requirements Active Philippine Registered Nurse (PHRN) 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 Important – Please Read Before Applying Your application will undergo an initial resume paper screening. Applications will be automatically rejected if your resume does not clearly demonstrate: At least 1 year of Clinical Appeals DRG experience in a Healthcare BPO Clinical Appeals Writing experience DRG Downcoding experience If your Clinical Appeals DRG experience is not clearly reflected in your work history, your application will not proceed to the next stage. Please update your resume before submitting your application.