PHRN Appeals DRG Specialist | DRG Appeals & Downcoding Exp Required | Work From Home | Up to ₱80K
About the role
WE'RE HIRING – PHRN PAS Appeals DRG Specialist | DRG Appeals & Downcoding Experience Required | Work From Home | Up to ₱80K
Location: Quezon City | Taguig City | Cebu Work Setup: Work From Home Shift: Night Shift Salary Package: ₱64,000–₱80,000 Start Date: September 24, 2026
Join our growing US Healthcare team as a PHRN PAS Appeals DRG Specialist. We are looking for experienced nurses with a strong background in DRG Appeals, DRG Downcoding, Clinical Appeals Writing, Medical Necessity Reviews, and Clinical Documentation Improvement (CDI).
Qualifications
Active PHRN License
College Graduate – BS Nursing
At least 6 months to 1+ year of Clinical Appeals Writing experience
Hands-on experience in DRG Appeals and DRG Downcoding is required
Experience writing appeal letters for:
Medical Necessity Denials
Authorization Denials
DRG Downgrades
Readmission Cases
Familiar with DRG Downcoding and Coding Appeals
Knowledge of MCG, InterQual, and ICD-10 Coding Guidelines
Experience using SOFA, KDIGO, GLIMS, and ASPEN criteria
Experience in Medical Coding, Clinical Documentation Improvement (CDI), or DRG Validation/Downcoding
Experience with MS-DRG and APR-DRG is highly preferred
Excellent clinical writing, analytical, and communication skills
Willing to work on a Night Shift
Job Responsibilities
Review medical records and prepare evidence-based clinical appeal letters.
Handle DRG Appeals, DRG Downcoding Appeals, Medical Necessity Denials, Authorization Denials, and Readmission Cases.
Apply MCG, InterQual, ICD-10 Coding Guidelines, and payer policies to support appeal recommendations.
Utilize SOFA, KDIGO, GLIMS, and ASPEN criteria when reviewing clinical documentation.
Collaborate with physicians, coders, CDI specialists, and healthcare teams to improve appeal outcomes.
Ensure compliance with client standards, healthcare regulations, and quality expectations.
Meet productivity, turnaround time, and quality metrics.
If you have hands-on experience in DRG Appeals and DRG Downcoding, this is an excellent opportunity to work from home while advancing your career in the US Healthcare industry.
Pay: Php70,000.00 - Php80,000.00 per month
Benefits:
Paid training
Work Location: Hybrid remote in Cebu City
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