Experienced Healthcare Forensics Auditor – Payment Integrity

BDO USA, Llp; Costa Mesa (CA); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO USA, LLP is seeking an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies in healthcare claims across disputes, fraud, waste, and abuse investigations. The role demands strong knowledge of reimbursement methodologies and regulatory frameworks, with the ability to deliver high-quality analyses for clients.

You will analyze claims data, develop corrective actions, and communicate complex information clearly while collaborating with cross-functional teams

Qualifications

• Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity.
• Experience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing preferred.
• Active credential in one or more: CPC, CCS, RHIA, CHC.

Responsibilities

• Investigate and analyze payment accuracy across healthcare claims.
• Identify improper payments, billing errors, and potential fraud, waste, or abuse.
• Develop strategies to improve payment accuracy and reduce overpayments.
• Prepare detailed reports and present findings to clients and internal stakeholders.
• Collaborate with cross-functional teams to validate findings and propose corrective actions.
• Interpret payer policies and provider contracts to assess claim appropriateness.
• Support development of payment integrity tools and audit methodologies.
• Stay current on CMS regulations and emerging payment models.

Skills

Communication skills

Project management

Problem solving

Education

High School Diploma or equivalent

Bachelor's degree in Healthcare Administration/Public Health/Business

Tools

Excel

SQL

SAS

Tableau

EPIC

Cerner

Athena

Coding/DRG software

Job description

BDO USA, LLP is seeking an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies in healthcare claims across disputes, fraud, waste, and abuse investigations. The role demands strong knowledge of reimbursement methodologies and regulatory frameworks, with the ability to deliver high-quality analyses for clients.

You will analyze claims data, develop corrective actions, and communicate complex information clearly while collaborating with cross-functional teams