Healthcare Forensics Analyst - Payment Integrity

DaMar Staffing; Cincinnati (OH); On-site; USD 65,000 - 85,000; Full time

Job summary

DaMar Staffing is seeking an Experienced Associate, Healthcare Forensics to identify, analyze, and resolve payment inaccuracies across healthcare claims within reimbursement disputes, fraud, waste, and abuse investigations.

The role requires strong data analytics, regulatory knowledge, and the ability to present findings to clients and stakeholders. The position emphasizes professional collaboration and proactive information gathering in a fast-paced environment.

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.
• Familiarity with regulatory analytics and fraud analytics.

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 developing documents, procedures, and solutions on non-billable practice development initiatives
• Other duties as required

Skills

Analytical thinking

Attention to detail

Problem-solving

Communication skills

Education

High School Diploma

Bachelor's degree in Healthcare Administration

Bachelor's degree in Public Health

Bachelor's degree in Business

Tools

Excel

SQL

SAS

Tableau

Job description

DaMar Staffing is seeking an Experienced Associate, Healthcare Forensics to identify, analyze, and resolve payment inaccuracies across healthcare claims within reimbursement disputes, fraud, waste, and abuse investigations.

The role requires strong data analytics, regulatory knowledge, and the ability to present findings to clients and stakeholders. The position emphasizes professional collaboration and proactive information gathering in a fast-paced environment.