Experienced Associate, Forensics

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, preferred

Experience 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 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

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