DRG Nurse Auditor - Prescreener

“SHPS is dedicated to driving, innovating and delivering healthcare consumerism for our clients, partners and participants. Our broad range of clinical, financial and benefit solutions enable and encourage wise healthcare consumerism, promote better health, lower healthcare costs, and maximize the quality and value of today’s healthcare.”


Job Skills/Requirements
The purpose of this position is to do the Analysis of diagnosis and procedures to assure correct DRG is assigned.

-Reviews all cases decoding all diagnosis and procedures and comparing to bill summary to assure charges are in appropriate areas.
-Verifies that primary diagnosis is the reason for admission.
-Verifies that all ccs are appropriate and documented in medical records.
-Verifies that DRG is appropriate of the diagnosis and procedures.
-Discusses any changes with the medical facility and obtain a signed agreement.
-Prepares report of the customer stating the change in DRG, the savings and charges.
-Finalizes case in the system showing the savings, charges and providing detailed documentation on the method used to obtain the savings.
-Maintains open communication.
-Must be detailed oriented.
-Must be able to work with deadlines.
-Must have ability to organize and prioritize.
-Performs other duties as required.

Job Skills/Requirements
-Must be a graduate of an accredited school of nursing and have current registration in the state of employment, or reciprocal state.
-Minimum of three years clinical hospital experience.
-Need good verbal and written communication skills.
-General computer skills - familiarity with CPT, DRG, ICD9, and UB 82/92 a plus.
-Some critical care experience preferred.

Screening Requirements: Drug Screen, Criminal Background Check

Please apply online at www.shps.com/careers