Experienced Associate, Forensics Healthcare Analytics

Job Summary:

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.

Job Duties:

• 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

Supervisory Responsibilities:

• N/A

Qualifications, Knowledge, Skills, and Abilities:

Education:

• High School Diploma or equivalent, required
• Bachelor’s degree in Healthcare Administration, Public Health, or Business, preferred

Experience:

• 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
• Experience in the following areas, preferred: 
  • Forensic Analytics
  • Compliance Analytics
  • Artificial Intelligence
  • Fraud Analytics

License/Certifications:

• Nationally recognized coding credential (e.g. CPC, CCS, RHIA, RHIA), preferred 
• Certified in Healthcare Compliance (CHC), preferred

Software:

• 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

Other Knowledge, Skills & Abilities:

• 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

Join us at BDO, where you will find more than a career, you’ll find a place where your work is impactful, and you are valued for your individuality. We offer flexibility and opportunities for advancement. Our culture is centered around making meaningful connections, approaching interactions with curiosity, and being true to yourself, all while making a positive difference in the world. 

At BDO, our purpose of helping people thrive every day is at the heart of everything we do. Together, we are focused on delivering exceptional and sustainable outcomes and value for our people, our clients, and our communities. BDO is proud to be an ESOP company, reflecting a culture that puts people first, by sharing financially in our growth in value with our U.S. team.  BDO professionals provide assurance, tax and advisory services for a diverse range of clients across the U.S. and in over 160 countries through our global organization.

BDO is the first large accounting and advisory organization to implement an Employee Stock Ownership Plan (ESOP). A qualified retirement plan, the ESOP offers participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well-being. The ESOP stands as a compelling addition to our comprehensive compensation and Total Rewards benefits* offerings. The annual allocation to the ESOP is fully funded by BDO through investments in company stock and grants employees the chance to grow their wealth over time as their shares vest and grow in value with the firm’s success, with no employee contributions. 

We are committed to delivering exceptional experiences to middle market leaders by sharing insight-driven perspectives, helping companies take business as usual to better than usual. With industry knowledge and experience, a breadth and depth of resources, and unwavering commitment to quality, we pride ourselves on:

• Welcoming diverse perspectives and understanding the experience of our professionals and clients
• Empowering team members to explore their full potential
• Our talented team who brings varying skills, knowledge and experience to proactively help our clients navigate an expanding array of complex challenges and opportunities
• Celebrating ingenuity and innovation to transform our business and help our clients transform theirs
• Focus on resilience and sustainability to positively impact our people, clients, and communities
• BDO Total Rewards that encompass so much more than traditional “benefits.”  Click here to find out more!

*Benefits may be subject to eligibility requirements.

Equal Opportunity Employer, including disability/vets

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