Healthcare Forensics Auditor — Payment Integrity Specialist

BDO; San Diego (CA); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO is seeking an Experienced Associate in Healthcare Forensics to analyze and resolve payment inaccuracies across healthcare claims, supporting disputes, fraud, waste, and abuse investigations and regulatory compliance. The role requires expertise in reimbursement methodologies, payer policies, and data-driven problem solving.

The candidate will investigate claims data, develop corrective actions, prepare client-ready reports, and work with cross-functional teams to improve payment integrity

Qualifications

• Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity.
• Experience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing.
• Active credential in one or more of the following: CPC, CCS, RHIA, RHIA or CHC.

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

Forensic Analytics

Compliance Analytics

Artificial Intelligence

Fraud Analytics

Education

Bachelor's degree in Healthcare Administration

High School Diploma

Tools

Excel

SQL

SAS

Tableau

Job description

BDO is seeking an Experienced Associate in Healthcare Forensics to analyze and resolve payment inaccuracies across healthcare claims, supporting disputes, fraud, waste, and abuse investigations and regulatory compliance. The role requires expertise in reimbursement methodologies, payer policies, and data-driven problem solving.

The candidate will investigate claims data, develop corrective actions, prepare client-ready reports, and work with cross-functional teams to improve payment integrity