	Human Capital Management

	#200210-UNCY-35
	Supplemental Questionnaire


Last Name	First Name

Do you have a current/valid Oklahoma RN license?

Yes No

I have three (3) years of clinical experience in health care monitoring (e.g., quality assurance, surveillance and utilization review, auditing, health policy), clinical coding, and reimbursement, clinical review of claims and claims auditing. I also have experience using database applications.

Yes No

Do you have certification as a Certified Professional Coder (CPC)?

I hold a Certified Professional Coder (CPC) certification.

I do not hold a Certified Professional Coder (CPC) certification.

Do you have an advanced nursing degree?

I have a Masters in Nursing or higher.

I have a Bachelors in Nursing.

I have an Associates in Nursing.

I do not have a degree.

Do you have Medicaid experience?

I have 6 or more years of Medicaid experience.

I have 3-5 years of Medicaid experience.

I have 1-2 years of Medicaid experience.

I have less than one year of Medicaid experience.

Do you have managed care experience?

I have 6 or more years of managed care experience.

I have 3-5 years of managed care experience.

I have 1-2 years of managed care experience.

I have less than 1 year of managed care experience.

Do you have coding experience?

I have 6 or more years of coding experience.

I have 3-5 years of coding experience.

I have 1-2 years of coding experience.

I have less than 1 year of coding experience.

Do you have utilization experience?

I have 6 or more years of utilization experience.

I have 3-5 years of utilization experience.

I have 1-2 years of utilization experience.

I have less than one year of utilization experience.

Do you have policy development experience?

I have 6 or more years of policy development experience.

I have 3-5 years of policy development experience.

I have 1-2 years of policy development experience.

I have less than one year of policy development experience.

Do you have quality assurance/improvement experience?

I have 6 or more years of quality assurance/improvement experience.

I have 3-5 years of quality assurance/improvement experience.

I have 1-2 years of quality assurance/improvement experience.

I have less than one year of quality assurance/improvement experience.