Healthcare Forensics Analyst: Payments & Compliance

BDO; Potomac (MD); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO is seeking an Experienced Associate, Healthcare Forensics in Maryland to identify, analyze, and resolve payment inaccuracies across healthcare claims related to reimbursement disputes, fraud, and compliance. The role requires strong data analysis, regulatory knowledge, and professional integrity.

The candidate will investigate claims, collaborate with cross-functional teams, and develop actionable recommendations, while staying current on CMS regulations and emerging payment models.

Qualifications

• High School Diploma or equivalent is required.
• Bachelor’s degree in Healthcare Administration, Public Health, or Business is preferred.
• Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity is required.
• Experience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing is preferred.

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.

Skills

Problem solving

Detail oriented

Communication

Project management

Education

High School Diploma or equivalent

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

Tools

Excel

SQL

SAS

Tableau

Job description

BDO is seeking an Experienced Associate, Healthcare Forensics in Maryland to identify, analyze, and resolve payment inaccuracies across healthcare claims related to reimbursement disputes, fraud, and compliance. The role requires strong data analysis, regulatory knowledge, and professional integrity.

The candidate will investigate claims, collaborate with cross-functional teams, and develop actionable recommendations, while staying current on CMS regulations and emerging payment models.