BDO
From BDO's careers page
Status: listed on the employer's own careers page when we last checked (daily). Confirm on their site before applying.
The Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients.
Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance matters
Contributes to forensic engagements related to medical coding and billing, revenue cycle, payment integrity, the False Claims Act, the Stark Law, the Anti-Kickback Statute, and other matters
Analyzes healthcare claims data to identify improper payments, billing errors, and potential fraud, waste, or abuse
Develops and implements strategies to improve payment accuracy and mitigate overpayments
Collaborates with cross-functional teams to validate findings and recommend corrective actions
Interprets payer policies, provider contracts, and regulatory guidelines to assess claim appropriateness
Prepares and present detailed reports and recommendations to clients and internal stakeholders
Supports the design and enhancement of payment integrity tools, algorithms, and audit methodologies
Stays current on industry trends, CMS regulations, and emerging payment models.
Develops working relationships with internal and external stakeholders and communicates effectively
Assists with the preparation of high-quality deliverables to ensure client satisfaction
Acts with professionalism and integrity when working with confidential and sensitive information
Maintains a proactive and logical approach to information gathering, combining complex ideas and clear and effective information presentation
Identifies and researches new trends, tools, and understands the data analytics marketplace while working on client engagements
Assists with developing documents, procedures, and solutions on non-billable practice development initiatives
Other duties as required
N/A
High School Diploma or equivalent, required
Bachelor’s degree in Healthcare Administration, Public Health, or Business, preferred
Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity, required
Experience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing, preferred
Forensic Analytics
Compliance Analytics
Artificial Intelligence
Fraud Analytics
Active credential in one (1) or more of the following, required: Nationally recognized coding credential (e.g. CPC, CCS, RHIA, RHIA) and/or Certified in Healthcare Compliance (CHC)
Proficiency in data analysis tools (e.g., Excel, SQL, SAS, Tableau), preferred
Prior experience with Electronic Health Record software (e.g., EPIC, Cerner, Athena, etc.), preferred
Coding/DRG software, preferred
Ability to work with a high degree of professionalism and autonomy
Excellent verbal and written communication skills
Ability to communicate complex information in a clear and concise manner
Excellent communication, problem-solving, and project management skills
Ability to work independently and manage multiple priorities in a fast-paced environment
Solid organizational skills, especially the ability to meet project deadlines with a focus on details
Ability to successfully multi-task while working independently or within a group environment
Ability to work in a deadline-driven environment, and handle multiple projects simultaneously
Ability to interact effectively with people at all organizational levels of the Firm
Ability to work collaboratively with others with accountability for work product
Keywords: Forensic, Healthcare Coding, Payment Integrity, Revenue Integrity, Revenue Cycle Management, Consulting, Disputes, Litigation, Investigation, Fraud, Waste, Abuse, Coding Auditor, Charge Capture, Healthcare Compliance
Individual salaries that are offered to a candidate are determined after consideration of numerous factors including but not limited to the candidate’s qualifications, experience, skills, and geography.
National Range: $65,000 - $85,000
Maryland Range: $65,000 - $85,000
NYC/Long Island/Westchester Range: $65,000 - $85,000
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