Experienced Healthcare Forensics & Payment Integrity Analyst

BDO; Melville (NY); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO is seeking an Experienced Associate in Healthcare Forensics in the Melville/NY area. The role focuses on analyzing payment inaccuracies in healthcare claims, supporting disputes, and regulatory/compliance engagements for diverse clients.

You will work with data across Medicare, Medicaid, and commercial payers, applying auditing tools, coding knowledge, and analytics to identify improper payments and propose corrective actions.

Qualifications

• Three 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.
• Active credential in one or more of the following: CPC, CCS, RHIA, CHC.
• Proficiency in data analysis tools (Excel, SQL, SAS, Tableau).

Responsibilities

• Investigate and analyze payment disputes for a variety of clients, including regulators and litigation matters.
• Identify improper payments, billing errors, and potential fraud, waste, or abuse.
• Develop strategies to improve payment accuracy and mitigate overpayments.
• Prepare and present detailed reports and recommendations to clients and internal stakeholders.

Skills

Forensic Analytics

Compliance Analytics

Artificial Intelligence

Fraud Analytics

Excel

SQL

SAS

Tableau

Communication skills

Education

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

High School Diploma or equivalent

Tools

EPIC

Cerner

Athena

Coding/DRG software

Job description

BDO is seeking an Experienced Associate in Healthcare Forensics in the Melville/NY area. The role focuses on analyzing payment inaccuracies in healthcare claims, supporting disputes, and regulatory/compliance engagements for diverse clients.

You will work with data across Medicare, Medicaid, and commercial payers, applying auditing tools, coding knowledge, and analytics to identify improper payments and propose corrective actions.