Registered Nurse Appeals Writer CheckList

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

KNOWLEDGE, SKILLS, ABILITIES Rating Stars (Click) 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 
Age Specific Competencies Rating Stars (Click) 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)