Senior Healthcare Forensics & Payment Integrity Analyst

BDO; Omaha (NE); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO is seeking an Experienced Associate for Healthcare Forensics in the United States. The role focuses on identifying, analyzing, and resolving payment inaccuracies across healthcare claims related to reimbursement disputes, fraud, waste, and abuse investigations, regulatory compliance, and litigation.

The candidate should have strong data analysis skills and knowledge of reimbursement methodologies. The position involves investigative analysis for a variety of clients, preparation of detailed

Qualifications

• Three (3) years of experience 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.
• Experience in Forensic Analytics, Compliance Analytics, Artificial Intelligence, or Fraud Analytics, preferred.
• Active credential in one or more of the following: CPC, CCS, RHIA, RHIA and/or CHC, required.

Responsibilities

• Provides investigation and analysis to clients including outside counsel, regulators, and entities involved in litigation and compliance 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.
• Stays current on CMS regulations and emerging payment models.

Skills

Communication skills

Analytical thinking

Project management

Independent work

Education

Bachelor’s degree in Healthcare Administration

High School Diploma or equivalent

Tools

Excel

SQL

SAS

Tableau

EPIC

Cerner

Athena

Coding/DRG software

Job description

BDO is seeking an Experienced Associate for Healthcare Forensics in the United States. The role focuses on identifying, analyzing, and resolving payment inaccuracies across healthcare claims related to reimbursement disputes, fraud, waste, and abuse investigations, regulatory compliance, and litigation.

The candidate should have strong data analysis skills and knowledge of reimbursement methodologies. The position involves investigative analysis for a variety of clients, preparation of detailed