Note: The job is a remote job and is open to candidates in USA. BDO USA provides professional assurance, tax, and advisory services to clients across the U.S. and around the world. The Experienced Associate, Healthcare Forensics Coder investigates healthcare claims and payment inaccuracies related to reimbursement disputes, fraud, waste, abuse, regulatory compliance, and litigation. The role analyzes claims data, develops payment-integrity strategies, prepares client deliverables, and supports forensic analytics and audit methodologies.
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
- 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
Skills
- High School Diploma or equivalent, required
- Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity, required
- 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)
- Ability to work with a high degree of professionalism and autonomy
- Excellent verbal and written communication skills
- Ability to communicate complex information in a clear and concise manner
- Excellent communication, problem-solving, and project management skills
- Ability 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
- Bachelor's degree in Healthcare Administration, Public Health, or Business, preferred
- Experience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing, preferred
- Forensic Analytics
- Compliance Analytics
- Artificial Intelligence
- Fraud Analytics
- 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
Benefits
- BDO is an ESOP company, offering participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well-being.
- The ESOP is a qualified retirement plan and a meaningful addition to BDO’s comprehensive compensation and Total Rewards benefits offerings.
Company Overview
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