Healthcare Forensics Associate: Payment Integrity Analytics

BDO; Cherry Hill Township (NJ); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO seeks an Experienced Associate, Healthcare Forensics in New Jersey to perform analytical investigations of payment inaccuracies across healthcare claims, addressing reimbursement disputes, fraud, waste, and abuse. The role requires understanding reimbursement methodologies, claims data, and regulatory frameworks, with an investigative mindset for high-quality client deliverables.

The position involves analyzing data, interpreting policies, and developing strategies to improve accuracy,

Qualifications

• High School Diploma required.
• Bachelor’s degree in Healthcare Admin/Public Health/Business preferred.
• Three years of healthcare consulting, revenue cycle, claims auditing, or payment integrity experience required.
• Experience with Medicare/Medicaid/Commercial reimbursement preferred.

Responsibilities

• Provide investigation and analysis to clients, regulators, and litigation matters.
• Contribute to forensic engagements on medical coding, billing, and payment integrity.
• Analyze claims data to identify improper payments or fraud.
• 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 present recommendations to clients.
• Support design of payment integrity tools and audit methods.
• Stay current on CMS regulations and payment models.

Skills

Analytical thinking

Communication skills

Project management

Deadline-driven

Independent work

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

BDO seeks an Experienced Associate, Healthcare Forensics in New Jersey to perform analytical investigations of payment inaccuracies across healthcare claims, addressing reimbursement disputes, fraud, waste, and abuse. The role requires understanding reimbursement methodologies, claims data, and regulatory frameworks, with an investigative mindset for high-quality client deliverables.

The position involves analyzing data, interpreting policies, and developing strategies to improve accuracy,