Healthcare Forensics Auditor & Payments Analyst

BDO; Chicago (IL); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO is seeking an Experienced Associate, Healthcare Forensics in Chicago. The role emphasizes analytical review of payment integrity, leveraging claims data to identify improper payments and guide corrective actions.

Qualifications include 3+ years in healthcare consulting, coding knowledge, and relevant credentials. The position requires strong communication and project management skills in a fast-paced environment.

Qualifications

• Three years of healthcare consulting, revenue cycle, claims auditing, or payment integrity experience required.
• Experience with Medicare/Medicaid, coding (ICD-10, CPT, HCPCS), and claims processing preferred.
• Active credential in one or more of: CHC or a nationally recognized coding credential (e.g., CPC, CCS, RHIA).
• Proficiency in data analysis tools (Excel, SQL, SAS, Tableau) 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, Stark Law, 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 presents detailed reports and recommendations to clients and internal stakeholders.
• Stays current on CMS regulations and emerging payment models.

Skills

Excellent communication

Project management

Data analysis

Education

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

High School Diploma or equivalent

Tools

Excel

SQL

SAS

Tableau

EPIC

Job description

BDO is seeking an Experienced Associate, Healthcare Forensics in Chicago. The role emphasizes analytical review of payment integrity, leveraging claims data to identify improper payments and guide corrective actions.

Qualifications include 3+ years in healthcare consulting, coding knowledge, and relevant credentials. The position requires strong communication and project management skills in a fast-paced environment.