Experienced Associate, Healthcare Forensics

Experienced Associate, Healthcare Forensics

Job Summary : 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 presents 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

Supervisory Responsibilities : N / A

Qualifications, Knowledge, Skills, and Abilities :

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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