Cathi M. Email & Phone Number

Tallahassee, Fl, Us

Remote

Perform evaluation and development of complaints to determine if referral as an investigation is warrantedConduct independent reviews resulting from the discovery of situations that potentially involve fraud or abuseUtilize basic data analysis techniques to detect aberrancies in Medicare claims data, and proactively seeks out and develops leads received from a variety of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)Review information contained in standard claims… Show more Perform evaluation and development of complaints to determine if referral as an investigation is warrantedConduct independent reviews resulting from the discovery of situations that potentially involve fraud or abuseUtilize basic data analysis techniques to detect aberrancies in Medicare claims data, and proactively seeks out and develops leads received from a variety of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)Review information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare policies and initiates appropriate actionMake potential fraud determinations by utilizing a variety of sources such as internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security ActCompile and maintain documentation and information related to investigations, cases, and/or leadsParticipate in onsite audits in conjunction with investigation developmentDevelop and prepare potential Fraud Alerts and Program Vulnerabilities for submission to CMS; share information on current fraud investigations with other Medicare contractors, law enforcement, and other applicable stakeholdersPerform other duties as assigned by PI Supervisor or PI Manager that contribute to task order goals and objectives Show less

Tallahassee, Florida

Tallahassee, Florida

Office and Marketing Manager for Chiropractic Care and state of the art aesthetics.

Sneads, Florida, United States

Certificate, Massage Therapy/Therapeutic Massage

Certificate, Aesthetician/Esthetician And Skin Care Specialist

Certificate, Criminal Justice And Corrections