Jacqueline Link Email & Phone Number

• Conduct independent investigations to discover potential fraud, waste, or abuse.• Utilize data analysis techniques to detect aberrancies in Medicare and Medicaid claims data, and proactively seek out and develop leads received from a variety of sources (e.g., CMS, OIG).• Complete written referrals to law enforcement and take steps to initiate recoupment of overpaid monies.• Review claims processing 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 action.• Make potential fraud determinations by utilizing ZPIC internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security Act.• Present information on fraud investigations to other Medicare and Medicaid contractors, law enforcement, and other stakeholders.• Perform onsite audits in conjunction with investigation development.

Conducts independent reviews resulting from the discovery of situations that potentially involve fraud or abuse • Evaluates and develops complaints to determine if referral to higher level of investigation is warranted • Plans, designs and carries out investigations of Medicare fraud by focusing on identifying deviant claims patterns and fraud indicators • Works as part of a team investigators, data analysts, statisticians, medical professionals, law enforcement agencies etc to develop proactive fraud detection projects and to investigate specific reactive cases • Identifies national fraud trends and prepares fraud alerts and vulnerability reports to advise other organizations of potential fraud risks • Performs other duties as assigned by the program director that contribute to organizational goals and mission • Ensures payments made by the Medicare Trust Fund are appropriate and consistent with Medicare coverage, coding and audit policies

Master'S Degree, Management

Public Management With A Concentration In Criminal Justice, Criminal Justice