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.
| KNOWLEDGE, SKILLS, ABILITIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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) |
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