Lindsey Motter
Dauphin
Summary
Professional Auditor with expertise in fraud detection and prevention, recognized for exceptional productivity and efficiency. Specialized in medical review and evidence gathering, with a strong ability to identify patterns indicative of fraudulent activities. Proven problem-solving and critical thinking skills enhance decision-making processes in high-pressure environments. Consistently delivers high-quality work while adapting to rapid changes and tight deadlines.
Overview
17
17
years of professional experience
Work History
Medicaid Fraud Analyst II
Pennsylvania Office of Attorney General
<ul>
<li>Collaborated with law enforcement to gather evidence for ongoing investigations.</li>
<li>Reviewed documents to detect discrepancies and potential fraud indicators.</li>
<li>Utilized specialized software tools designed for detecting patterns associated with fraudulent activity.</li>
<li>Documented all investigative findings in a clear, concise manner for senior management review.</li>
</ul>
05.2023 - Current
- Collaborated with third parties to gather evidence.
- Reviewed documents to detect discrepancies and potential fraud indicators.
- Reviewed complaints and reports that showed potential suspicious activity.
- Input information regarding fraud investigations into detailed reports for submission to management.
- Reviewed confidential and highly sensitive material concerning various parties.
Adjunct Instructor - Medical Coding
Harrisburg Area Community College
<ul>
<li>Develop course materials aligned with college curriculum standards.</li>
<li>Assess student performance through tests and assignments.</li>
<li>Provide academic advising to support student success and retention.</li>
<li>Collaborate with faculty to enhance instructional strategies and resources.</li>
<li>Promote a positive learning environment by encouraging critical thinking skills among students.</li>
<li>Lecture and communicate effectively with students from diverse backgrounds.</li>
</ul>
01.2022 - Current
- Develop course materials aligned with college curriculum standards.
- Assess student performance through tests and assignments.
- Provide academic advising to support student success and retention.
- Collaborate with faculty to enhance instructional strategies and resources.
- Promote a positive learning environment by encouraging critical thinking skills among students.
- Lecture and communicate effectively with students from diverse backgrounds.
Risk Adjustment Auditor & Education Training Consultant
Elevance Health
03.2016 - 10.2022
- Mitigated payment error risk through auditing, education, and training on coding and documentation for partner providers and clinicians.
- Provided oversight, guidance, and training related to CMS guidelines, and HCC best practices.
- Developed training programs and tools, as well as educated providers on performance improvement opportunities.
- Performed internal process and policy audits.
- Collaborated with cross-functional teams to enhance audit processes.
Clinical Quality Auditor Lead
Elevance Health
03.2016 - 10.2022
- Created educational materials for providers and internal staff.
- Requested and collected data and/or medical charts to support HEDIS and STARS initiatives.
- Conducted thorough audits of quality processes and compliance standards.
- Evaluated internal procedures for adherence to regulatory requirements.
- Collaborated with teams to identify areas for quality improvement initiatives.
- Recommended changes in processes to improve quality levels.
- Maintained all relevant documents related to inspections and audits in an organized manner.
Senior Provider Reimbursement Administrator
Elevance Health
03.2016 - 10.2022
- Worked closely with the Director as part of the Leadership Team to transform the current operating model by developing reporting processes, identifying issues, and recommending process improvements related to workload management and reporting.
- Provided data analysis support to the E/M Leveling management team by developing a reporting process for identifying disputed E/M leveling claims.
- Audited claims for completion, as well as identified and reported suspected fraud, waste, or abuse to the SIU.
- Completed project management and/or clinical research projects for inquiries and coding projects.
- Implemented improvements in record-keeping practices for better accessibility.
Clinical Provider Auditor, II
Elevance Health
03.2016 - 10.2022
- Conducted SIU reviews on selected provider claims based on Medicare or Medicaid guidelines.
- Prepared detailed audit outcome reports, summarizing findings and recommendations.
- Ensured timely completion of all assigned tasks within set deadlines.
- Reviewed compliance with regulations and company policies during audits.
- Utilized auditing software to streamline reporting and analysis tasks.
Medical Policy Analyst
Highmark Inc.
Camp Hill
07.2014 - 08.2015
- Developed utilization management precertification criteria for medical policies.
- Researched medical studies and clinical trials to determine the effectiveness of a treatment or product.
- Served as a liaison to business units for the correct coding of claims.
- Researched questions and issues from external sources, as well as internal physicians and nurses, as they related to the development of medical policies.
- Worked directly with third-party vendors to write and/or incorporate their products into a new or existing medical policy.
Utilization Review/Utilization Management Nurse
Aetna
Harrisburg
08.2013 - 07.2014
- Call center/front-line provider contact.
- Utilized the InterQual system to review clinical information related to procedures, DME, and home health care requests to determine medical necessity.
- Reviewed current commercial, state-specific Medicaid policies, Medicare NCD/LCDs, individual/employer-provided commercial plans, and Medicare Advantage plans.
- Reviewed clinical documentation to verify compliance with guidelines and policies.
Clinical Nurse Reviewer
Novitas Solutions, Inc.
Mechanicsburg
08.2008 - 08.2013
- Reviewed pre- and post-payment cases related to suspected fraud, waste, and abuse, as defined by CMS.
- Educated providers on current coding guidelines and best practices for documentation accuracy.
- Coordinated the return of monies related to post-payment audits.
- Opened and maintained all long-term prepayment cases (prepayment edits).
- Researched and investigated all claims related to provider referrals.
- Submitted case materials for referrals to the OIG.
- Participated in full-scale investigations related to fraud, waste, and abuse.
Education
Associate - Healthcare Administration
Colorado Technical University
Colorado Springs, CO11-2015
Associate - General Studies
Harrisburg Community College
Harrisburg, PA12-2014
Certificate - Practical Nursing
Harrisburg Area Community College
Harrisburg, PA12-2006
Skills
- Medical policy development
- Educational training
- Data analysis
- ProFee auditing
- Compliance auditing
- E/M auditing
- Quality improvement
- Medical review
- Training development
- Project management
- Provider education
- Proficient in PowerPoint, Excel, Word, Outlook, MS Teams, Adobe Reader, Pro, and PDF conversion
- Evidence preparation and organization
Credentials
- LPN
- CPC
- CPMA
- CRC
- CPC-I
Affiliations
- AAPC Auditing Committee member 2020 - 2023
- AAPC Education Committee member 2021 - 2023
- Local AAPC Chapter Education Officer 2022 – 2024
- Local AAPC Chapter President 2025
References
References available upon request.
Timeline
Medicaid Fraud Analyst II
Pennsylvania Office of Attorney General
05.2023 - Current
Adjunct Instructor - Medical Coding
Harrisburg Area Community College
01.2022 - Current
Risk Adjustment Auditor & Education Training Consultant
Elevance Health
03.2016 - 10.2022
Clinical Quality Auditor Lead
Elevance Health
03.2016 - 10.2022
Senior Provider Reimbursement Administrator
Elevance Health
03.2016 - 10.2022
Clinical Provider Auditor, II
Elevance Health
03.2016 - 10.2022
Medical Policy Analyst
Highmark Inc.
07.2014 - 08.2015
Utilization Review/Utilization Management Nurse
Aetna
08.2013 - 07.2014
Clinical Nurse Reviewer
Novitas Solutions, Inc.
08.2008 - 08.2013
Associate - Healthcare Administration
Colorado Technical University
Associate - General Studies
Harrisburg Community College
Certificate - Practical Nursing
Harrisburg Area Community College