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