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