PAS Appeals (DRG)

Job Responsibilities:

• Appeal Letter Writing: Proven experience in composing appeal letters for various levels of
• appeals, showcasing a high success rate in securing approvals.
• Compliance: Familiarity with healthcare laws, regulations, medical care guidelines (MCG or
  InterQual) and insurance policies related to appeals and medical necessity criteria.
  Experience in writing appeals for different denial types including Medical Necessity
  Denials, Authorization Denials, DRG downgrades, and readmission cases.

Qualifications

• 6 months to 1 yr+ Clinical Appeals Writing Experience
• Familiar with use of MCG / InterQual guidelines / ICD-10 coding guidelines
• Medical Coding, CDI, or DRG downcode experience
• SOFA and KDIGO criteria experience
• Experience with MS-DRG (Medicare Severity; the more common DRG) and APR-DRG
  (All Patients Refined; the less common DRG) is preferred
• Must be a BS Nursing or Med Allied course
• Active PHRN license

Work Arrangements

Work Location

• Cebu, QC & Taguig

Work Setup

• WFH

Start date

• August 20, 2026

Benefits Offered

• Competitive Total Rewards Package
• Target variable incentives
• Medical Plan (HMO) from Day 1 of employment with free dependents
• Life insurance
• Paid Time-Off Benefits
• Sick Leave Conversion
• Night Differential offered
• Employee Referral Program
• All Mandatory Statutory Benefits

ENDORSEMENT PROCESS

• Endorse to R1 RCM Team
• R1 Team to validate the candidates and pre-screen the valid
• Workday profile creation for candidates
• Weekly Updates

HIRING PROCESS

• Endorsement to WD
• Assessment
• HM Interview
• Passed HM Interview
• Inform candidates of status (R1 to request recent pay slip – 1 month)
• Job Offer