Darrell Blackburn Email & Phone Number

Birmingham, Alabama Area

• Research and analyze provider data for case development in a multi-state jurisdiction • Prioritize case workloads by researching Medicare guidelines along with state and federal laws• Determine course of action for each case to determine if case should be developed to refer to law enforcement• Communicate technical information orally or by written referral• Facilitate, coordinate and implement training materials for the purpose of associate development

Birmingham, Alabama

•Responsible for applying analytical and technical skills to monitor, research, and track projects within the Project Management Office, Contract Management, Communications and Planning Departments•Serve as Zone Program Integrity Contractor Liaison to support company in all Benefit Integrity and Medical Review activities in order to share costs and reduce operating expenses •Complete assigned activities and projects within budget with quality and timeliness expectations

• Conduct investigations of providers for fraudulent behavior involving all health care funds • Research and analyze provider data for case development in a multi-state jurisdiction • Interview, analyze, and evaluate statements of witnesses or persons suspected of health care fraud

• Investigated and analyzed disability claims to determine the extent of the claimants condition • Interacted with physicians to discuss the severity of the claimants allegations, for medical record updates and special requests• Compared electronic health records and paper health records to claim applications, field office observations and medical evidence to ascertain completeness and validity of claim

• Served as liaison between Provider Services Department and the contracted provider community• Prepared monthly provider statistic spreadsheet reports for network contract line products• Conducted provider research and other product line studies including patient health data entry