Experienced Associate, Forensics

BDO USA; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

BDO USA in the United States is seeking an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies across healthcare claims, supporting reimbursement disputes, regulatory compliance, and litigation.

The role requires knowledge of reimbursement methodologies, claims data, and regulatory frameworks, with an investigative mindset and ability to deliver high-quality work for clients.

Qualifications

• High School Diploma or equivalent is required.
• Bachelor’s degree in Healthcare Administration, Public Health, or Business preferred.
• Three years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity required.
• Experience with Medicare, Medicaid, and commercial payer policies preferred.
• Active coding or healthcare compliance credential(s) such as CPC, CCS, RHIA, or CHC are required.

Responsibilities

• Investigation and analysis for clients, regulators, and companies involved in litigation and compliance matters.
• Contribute to engagements related to medical coding, revenue cycle, and payment integrity.
• Analyze claims data to identify improper payments and potential fraud, waste, or abuse.
• Develop strategies to improve payment accuracy and reduce overpayments.
• Collaborate with cross-functional teams to validate findings and recommend actions.
• Interpret payer policies and contracts to assess claim appropriateness.
• Prepare detailed reports and recommendations for clients and internal stakeholders.
• Support design and enhancement of payment integrity tools and audit methodologies.
• Stay current on CMS regulations and emerging payment models.
• Communicate findings effectively with internal and external stakeholders.

Skills

Analytical skills

Communication

Project management

Education

High School Diploma or equivalent

Bachelor’s degree in Healthcare Administration, Public Health, or Business

Tools

Excel

SQL

SAS

Tableau

Job description

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 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

Education

Qualifications, Knowledge, Skills, and Abilities

• 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

• 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)

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

About Us

At BDO, how we show up matters. We build strong relationships by supporting one another, our clients, and our communities with care, curiosity, and a commitment to helping one another grow and succeed. Here, you’ll find meaningful work, leaders invested in your success, and opportunities to build a career around what matters most to you.

Our purpose is to be the people our clients count on to grow with confidence and achieve what matters most. Our values guide how we bring that purpose to life each day. Together, they shape how we work with one another, serve our clients, and create meaningful impact.

BDO provides assurance, tax, and advisory services to clients across the U.S. and around the world. No matter your role, you’ll be part of a team helping clients navigate complexity and move forward with clarity.

We are proud to be an ESOP company, offering participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well‑being. As a qualified retirement plan, the ESOP is a meaningful addition to our comprehensive compensation and Total Rewards benefits* offerings. It also reinforces an ownership mindset that strengthens our connection to one another, our clients, and the future we’re building together.

Learn more about our benefits: BDO Total Rewards encompass more than traditional benefits.

• Benefits may be subject to eligibility requirements.

Equal Opportunity Employer, including disability/vets

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.

"BDO USA, P.A. is an EO employer M/F/Veteran/Disability"