Healthcare Forensics Associate: Payment Integrity

DaMar Staffing; Dallas (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

DaMar Staffing seeks an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies in healthcare claims, with focus on reimbursement disputes, fraud, waste, and abuse investigations. The role requires understanding payer policies, contracts, and regulatory guidelines, plus robust data analysis and reporting skills.

The successful candidate will work with cross-functional teams, deliver high-quality deliverables, and stay current on CMS regulations and evolving

Qualifications

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

Responsibilities

• Investigate and analyze to support litigation, regulatory, and compliance matters.
• Analyze claims data to identify improper payments, errors, 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.
• Prepare detailed reports and present recommendations to clients and internal stakeholders.
• Support development of payment integrity tools, algorithms, and audit methodologies.

Skills

Analytical thinking

Attention to detail

Communication

Project management

Multitasking

Autonomy

Team collaboration

Education

High School Diploma or equivalent

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

Tools

Excel

SQL

SAS

Tableau

EPIC

Cerner

Athena

Coding/DRG software

Job description

DaMar Staffing seeks an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies in healthcare claims, with focus on reimbursement disputes, fraud, waste, and abuse investigations. The role requires understanding payer policies, contracts, and regulatory guidelines, plus robust data analysis and reporting skills.

The successful candidate will work with cross-functional teams, deliver high-quality deliverables, and stay current on CMS regulations and evolving