Experienced Associate, Healthcare Forensics Coder

Posted 2 days ago

bdoColumbus (OH)

Health Information Technologists and Medical Registrars Other Scientific and Technical Consulting Services

SENIORITY

Senior

SALARY

$65,000 - $85,000 per year

Apply

About the role

Experienced Associate, Healthcare Forensics The Experienced Associate, Healthcare Forensics role is a highly analytical and detail-oriented individual responsible for identifying, analyzing, and resolving payment inaccuracies across healthcare claims as it relates to reimbursement disputes, fraud, waste, and abuse investigation, regulatory compliance, and litigation. The ideal candidate will bring a strong understanding of healthcare reimbursement methodologies, claims data, and regulatory frameworks. The Experienced Associate, Healthcare Forensics demonstrates an investigative mindset with problem solving skills and the ability to think critically about data to deliver high-quality work product for clients.

Job Duties:

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
Qualifications, Knowledge, Skills, and Abilities:

Education: High School Diploma or equivalent, required

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

Experience: 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, preferredExperience in the following areas, preferred:

Forensic Analytics
Compliance Analytics
Artificial Intelligence
Fraud Analytics

License/Certifications: Active credential in one (1) or more of the following, required: Nationally recognized coding credential (e.g. CPC, CCS, RHIA, RHIA) and/or Certified in Healthcare Compliance (CHC)

Software:

Proficiency in data analysis tools (e.g., Excel, SQL, SAS, Tableau), preferred
Prior experience with Electronic Health Record software (e.g., EPIC, Cerner, Athena, etc.), preferred
Coding/DRG software, preferred

Other Knowledge, Skills & Abilities:

Ability to work with a high degree of professionalism and autonomy
Excellent verbal and written communication skillsAbility to communicate complex information in a clear and concise manner
Excellent communication, problem-solving, and project management skillsAbility to work independently and manage multiple priorities in a fast-paced environment
Solid organizational skills, especially the ability to meet project deadlines with a focus on details
Ability to successfully multi-task while working independently or within a group environment
Ability to work in a deadline-driven environment, and handle multiple projects simultaneously
Ability to interact effectively with people at all organizational levels of the Firm
Ability to work collaboratively with others with accountability for work product
Keywords: Forensic, Healthcare Coding, Payment Integrity, Revenue Integrity, Revenue Cycle Management, Consulting, Disputes, Litigation, Investigation, Fraud, Waste, Abuse, Coding Auditor, Charge Capture, Healthcare Compliance

Individual salaries that are offered to a candidate are determined after consideration of numerous factors including but not limited to the candidate's qualifications, experience, skills, and geography. National Range: $65,000 - $85,000 Maryland Range: $65,000 - $85,000 NYC/Long Island/Westchester Range: $65,000 - $85,000

Before you apply

Applying takes about a minute. These four things decide how fast it moves after that.

Your profile is current

It's what we read first. Occupations, seniority and locations matter more than a long history.

Two examples you can talk through

Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.

A number in mind

What you're on now and what would make you move. We negotiate better when we know both.

Your notice period

Employers plan around it, and it's the question that stalls offers most often.

Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.