Manager, Healthcare Forensics

The Manager, Healthcare Forensics plays a critical role in supporting healthcare organizations through complex regulatory environments by leading forensic investigations, ensuring compliance, and resolving disputes. This position focuses on analyzing healthcare coding, billing, and payment integrity issues to identify fraud, waste, abuse, and operational inefficiencies. The ideal candidate brings a blend of healthcare expertise, investigative acumen, and regulatory knowledge.

• Leads and manages forensic investigations related to healthcare billing, coding, and reimbursement practices
• Conducts detailed reviews of claims data, medical records, and billing documentation to assess compliance with federal and state regulations (e.g., CMS, HIPAA, False Claims Act)
• Develops and implements methodologies for identifying anomalies, trends, and potential fraud or abuse
• Collaborates with legal counsel, compliance officers, and external regulators during audits, litigation, or dispute resolution
• Prepares detailed reports, presentations, and expert opinions for internal stakeholders and external clients
• Supervises and mentors junior staff, ensuring high-quality deliverables and professional development
• Stays current on healthcare regulatory changes, payer policies, and industry trends
• Builds and maintains strong relationships with internal staff members and clients
• Supports clients in developing corrective action plans and compliance programs to mitigate future risk
• Other duties as required

• Supervises the day-to-day workload on assigned engagements and reviews work product

• High School Diploma/GED AND seven (7) or more years of industry experience with healthcare revenue cycle, required; OR
• Bachelor’s degree AND five (5) or more years of industry experience with healthcare revenue cycle, required

• Five (5) or more years of healthcare revenue cycle operations or regulatory compliance-based experience, required
• Three (3) or more years of experience with medical coding for large group practices and/or hospitals, required

• Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT), required

• Proficiency in the use of Microsoft Office Suite, MS Project, Visio, and SharePoint, required
• Proficiency in the use of Epic, preferred

• Executive presence, with the ability to act as primary contact on assigned engagements
• Excellent verbal and written communication skills, as well as presentation skills
• Strong analytical and advanced research skills related to industry trends, market competition and technology
• 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
• Able to interact effectively with people at all organizational levels of the Firm and with clients
• Ability to encourage a team environment on engagements, and contribute to the professional development of assigned team members
• Ad hoc travel may be required
• Additional certification applicable to this work such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity

Keywords: Healthcare Consulting, Healthcare Compliance, Revenue Cycle, Payment Integrity, Medical Coding, Medical Billing, Revenue Integrity,CCS, CPC, RHIA, RHIT, Audit, Risk Management

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: $95,000 - $160,000

Maryland Range: $95,000 - $160,000

NYC/Long Island/Westchester Range: $95,000 - $160,000

Join us at BDO, where you will find more than a career, you’ll find a place where your work is impactful, and you are valued for your individuality. We offer flexibility and opportunities for advancement. Our culture is centered around making meaningful connections, approaching interactions with curiosity, and being true to yourself, all while making a positive difference in the world.

At BDO, our purpose of helping people thrive every day is at the heart of everything we do. Together, we are focused on delivering exceptional and sustainable outcomes and value for our people, our clients, and our communities. BDO is proud to be an ESOP company, reflecting a culture that puts people first, by sharing financially in our growth in value with our U.S. team.

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