PHRN Appeals DRG Specialist | DRG Appeals & Downcoding Exp Required | Work From Home | Up to ₱80K

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 National Capital Region