Registered Nurse Appeals Writer

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

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) *

Info