Healthcare Forensics & Coding Analyst

BDO USA, Llp; West Palm Beach (FL); In loco; USD 65.000 - 85.000; Tempo pieno

Descrizione del lavoro

BDO USA, LLP in West Palm Beach seeks an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies across healthcare claims within reimbursement disputes, fraud, waste, and abuse investigations, regulatory compliance, and litigation.

You will analyze claims data, interpret payer policies, prepare reports, and support development of payment integrity tools while collaborating with cross-functional teams to deliver high-quality client work.

Competenze

• Three years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity.
• Experience with Medicare, Medicaid, and commercial reimbursement processes.
• Familiarity with coding (ICD-10, CPT, HCPCS) and claims processing preferred.

Mansioni

• Provides investigation and analysis to clients, including outside counsel, regulators, and entities involved in litigation and compliance matters.
• Contributes to engagements related to medical coding and billing, revenue cycle, and payment integrity.
• Analyzes claims data to identify improper payments, billing errors, or potential fraud, waste, or abuse.
• Develops 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.

Conoscenze

Healthcare reimbursement

Data analysis

Regulatory compliance

Communication

Problem solving

Formazione

Bachelor's degree in Healthcare Administration/ Public Health/ Business

Strumenti

Excel

SQL

SAS

Tableau

Descrizione del lavoro

BDO USA, LLP in West Palm Beach seeks an Experienced Associate, Healthcare Forensics to identify and resolve payment inaccuracies across healthcare claims within reimbursement disputes, fraud, waste, and abuse investigations, regulatory compliance, and litigation.

You will analyze claims data, interpret payer policies, prepare reports, and support development of payment integrity tools while collaborating with cross-functional teams to deliver high-quality client work.