BDO USA · 5 days ago
Experienced Associate, Healthcare Forensics
United States
Full-time
Remote
Mid Level
$65K/yr - $85K/yr
3+ years expBDO USA is a leading accounting and advisory organization, and they are seeking an Experienced Associate in Healthcare Forensics. This role involves identifying, analyzing, and resolving payment inaccuracies in healthcare claims while collaborating with clients on regulatory compliance and fraud investigations.
AccountingConsultingFinancial Services
Responsibilities
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
Qualification
Required
High School Diploma or equivalent, required
Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity, required
Preferred
Bachelor's degree in Healthcare Administration, Public Health, or Business, preferred
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
Nationally recognized coding credential (e.g. CPC, CCS, RHIA, RHIA), preferred
Certified in Healthcare Compliance (CHC), preferred
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
Benefits
Employee Stock Ownership Plan (ESOP)
Flexibility and opportunities for advancement
Comprehensive compensation and Total Rewards benefits
Company
BDO USA
BDO USA renders taxation, audit, assurance, advisory, and business outsourcing services to companies across all sectors of the economy.
10001+ employees
H1B Sponsorship
BDO USA has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (92)
2024 (101)
2023 (119)
2022 (151)
2021 (105)
2020 (199)
Funding
Current Stage
Late StageTotal Funding
$1.3BKey Investors
Apollo
2023-08-15Debt Financing· $1.3B
Leadership Team
Wayne Berson
CEO and BDO Principal
Catherine Moy
Chief People Officer
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