Carmita Curtis

Initial part of the new project, Support to the State of Georgia Medicaid Programs.

Processing Intake, Renewal, Changes, case closures, and Pathways applications for the Georgia Medicaid Programs.

Operating in a remote/work-from-home setting.

Maintain the confidentiality of sensitive personal information of recipients in Georgia and the Deloitte Systems.

• Managed high-stress situations effectively, maintaining professionalism while being flexible to immediate changes.
• Exceeded performance metrics consistently, earning recognition status as a top performer within the team.
• Maintained up-to-date knowledge of policy and procedures for the Georgia State Medicaid Program.
• Responded proactively and positively to rapid change.
• Promptly responded to inquiries and requests from management.
• Followed through on all critical inter-departmental escalations to changes and new assignments.

• Investigated all provider types for billing for services not rendered, billing for services not medically necessary, up-coding, separating Medicaid billing cost, recipient solicitation, altering of records, and other program-related violations, including all Medicaid policy and Texas Administrative Code (TAC) violations.
• Coordinated with local, state, and federal regulatory and law enforcement agencies when appropriate, and referred cases suspected of criminal activity to the Office of the Attorney General's Medicaid Fraud Control Unit.
• Compiled and analyzed information regarding Medicaid providers' billing and activities.
• Developed case plans and conducted comprehensive investigation tactics to obtain necessary evidence.
• Testified under oath in administrative hearings and criminal court cases.
• Liaised with law enforcement agencies to investigate fraud.

• Assisted supervisor with on-going unit activities, staff development and policy interpretations.
• Completed assigned case readings to determine accuracy in casework using Eligibility and Office Inspector General (OIG) policies and procedures.
• Managed workload to ensure individual performance and unit goals are met.
• Planned, organized and managed workload to maximize productivity while meeting priorities and deadlines.
• Cleared and made determination on Income & Eligibility Verification System (IEVS)/Match reports in accordance with Program/OIG Policies and Procedures to assure quality standards.
• Maintained organized records of all information and material pertinent to open investigations.
• Ran background checks of individuals to obtain data on character, financial status and personal history.

• Conducted administrative investigation of persons committing fraud in the State of Texas Medicaid programs.
• Prepared, presented case evidence to testify at Administrative Disqualification Hearings.
• Maintained detailed case log of all cases assigned to monitor progress and completion.
• Maintained organized records of all information and material pertinent to open investigations.
• Conducted background information and established claims on overpayments in the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and Texas Medical Programs.