Healthcare Forensics Associate: Revenue Integrity

DaMar Staffing; Cleveland (OH); 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 across healthcare claims for reimbursement disputes, regulatory compliance, and litigation support. You will analyze claims data, develop strategies to improve payment accuracy, and collaborate with cross-functional teams.

The role requires 3 years of healthcare consulting or related experience, knowledge of Medicare/Medicaid coding, and proficiency in data analysis tools.

Qualifications

• Education: High School Diploma or equivalent.
• Bachelor's degree in Healthcare Administration, Public Health, or Business preferred.
• Experience: 3 years in healthcare consulting, revenue cycle, claims auditing, or payment integrity required.
• Experience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing 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
• Develops working relationships with internal and external stakeholders and communicates effectively
• Assists with the preparation of high-quality deliverables to ensure client satisfaction
• Acts with professionalism and integrity when working with confidential and sensitive information
• Maintains a proactive and logical approach to information gathering, combining complex ideas and clear and effective information presentation
• Identifies and researches new trends, tools, and understands the data analytics marketplace while working on client engagements
• Assists with developing documents, procedures, and solutions on non-billable practice development initiatives
• Other duties as required

Skills

Forensic Analytics

Compliance Analytics

Artificial Intelligence

Fraud Analytics

Communication

Education

High School Diploma or equivalent

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

Tools

Excel

SQL

SAS

Tableau

EPIC

Cerner

Athena

Job description

DaMar Staffing seeks an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies across healthcare claims for reimbursement disputes, regulatory compliance, and litigation support. You will analyze claims data, develop strategies to improve payment accuracy, and collaborate with cross-functional teams.

The role requires 3 years of healthcare consulting or related experience, knowledge of Medicare/Medicaid coding, and proficiency in data analysis tools.