Healthcare Forensics Analyst – Payment Integrity & Claims

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

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.