Registered Nurse Appeals Writer

Information

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Assessment Section

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 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 *
★ ★ ★ ★ ★
✔ 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 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

✔ 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) *
★ ★ ★ ★ ★