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
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
KNOWLEDGE, SKILLS, ABILITIES
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 hospital Utilization Review ("UR") regulations
Knowledge of Medicare guidelines regarding medical necessity
Knowledge 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
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 contracted 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
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)