About this opportunity
BDO USA lists this Experienced Associate, Healthcare Forensics Coder opportunity in potomac, Maryland. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Experienced Associate, Healthcare ForensicsThe 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 mattersContributes 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 mattersAnalyzes healthcare claims data to identify improper payments, billing errors, and potential fraud, waste, or abuseDevelops and implements strategies to improve payment accuracy and mitigate overpaymentsCollaborates with cross-functional teams to validate findings and recommend corrective actionsInterprets payer policies, provider contracts, and regulatory guidelines to assess claim appropriatenessPrepares and present detailed reports and recommendations to clients and internal stakeholdersSupports the design and enhancement of payment integrity tools, algorithms, and audit methodologiesStays current on industry trends, CMS regulations, and emerging payment models.Develops working relationships with internal and external stakeholders and communicates effectivelyAssists with the preparation of high-quality deliverables to ensure client satisfactionActs with professionalism and integrity when working with confidential and sensitive informationMaintains a proactive and logical approach to information gathering, combining complex ideas and clear and effective information presentationIdentifies and researches new trends, tools, and understands the data analytics marketplace while working on client engagementsAssists with developing documents, procedures, and solutions on non-billable practice development initiativesOther duties as requiredQualifications, Knowledge, Skills, and Abilities:Education:High School Diploma or equivalent, requiredBachelor's degree in Healthcare Administration, Public Health, or Business, preferredExperience:Three (3) years of experience in healthcare consulting, revenue cycle, claims auditing, or payment integrity, requiredExperience with healthcare reimbursement (Medicare, Medicaid, Commercial), coding (ICD-10, CPT, HCPCS), and claims processing, preferredExperience in the following areas, preferred:Forensic AnalyticsCompliance AnalyticsArtificial IntelligenceFraud AnalyticsLicense/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), preferredPrior experience with Electronic Health Record software (e.g., EPIC, Cerner, Athena, etc.), preferredCoding/DRG software, preferredOther Knowledge, Skills & Abilities:Ability to work with a high degree of professionalism and autonomyExcellent verbal and written communication skillsAbility to communicate complex information in a clear and concise mannerExcellent communication, problem-solving, and project management skillsAbility to work independently and manage multiple priorities in a fast-paced environmentSolid organizational skills, especially the ability to meet project deadlines with a focus on detailsAbility to successfully multi-task while working independently or within a group environmentAbility to work in a deadline-driven environment, and handle multiple projects simultaneouslyAbility to interact effectively with people at all organizational levels of the FirmAbility to work collaboratively with others with accountability for work productKeywords: Forensic, Healthcare Coding, Payment Integrity, Revenue Integrity, Revenue Cycle Management, Consulting, Disputes, Litigation, Investigation, Fraud, Waste, Abuse, Coding Auditor, Charge Capture, Healthcare ComplianceIndividual 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
Worksite address
potomac, MD, 20854, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.