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.
• 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.

• 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

Master'S Degree, Management

Public Management With A Concentration In Criminal Justice, Criminal Justice