LAST 4 OF SSN      
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

Rating Stars (Click) KNOWLEDGE, SKILLS, ABILITIES 1 2 3 4  
Review, analysis and extraction of clinical information from patient records  
Drafting of effective narratives for Medicare and Medicaid appeals documentation  
Drafted briefs in support of denied cases under appeal at all levels of the government appeals process  
Maintained current knowledge base of medical coding  
Knowledge of federal and state hopsital Utilization Review ("UR") regulations  
Knowledge of of Medicare guidelines regarding medical necessity  
Knowledge of of Medicare guidelines regarding inpatient and outpatient observation  
Research and preparation for beneficiary hearings  
Experience testifying as expert witness in hearings  
Collaborated with internal and external legal sources  
Chart review skills  
Ability to quickly research and extract relevant data from a medical record  
Develop and Draft clear narratives for a solid case in support of medical claims for appeals  
Experience with electronic medical record  
Knowledge and experience with acute hospital utilization review using InterQual and/or Milliman  
Working knowledge of medical coding  
Knowledge and experience with case management  
Knowledge and experience with government and contacted payers  
Attention to details, timeliness and accuracy  
Ability to work independently while working efficiently  
Ability to work comfortably within a high production team  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Infant (Birth - 1 year)  
Preschooler (ages 2-5 years)  
Childhood (ages 6-12 years)  
Adolescents (ages 13-21 years)  
Young Adults (ages 22-39 years)  
Adults (ages 40-64 years)  
Older Adults (ages 65-79 years)  
Elderly (ages 80+ years)