Description
The Experienced Associate, Healthcare Forensics investigates and resolves payment inaccuracies in healthcare claims across reimbursement disputes, fraud, waste, and abuse investigations, regulatory compliance, and litigation. The role analyzes claims data, evaluates coding and billing practices, identifies improper payments, develops payment-integrity strategies, prepares reports and recommendations, and supports audit methodologies and tools. It requires a high school diploma or equivalent, three years of relevant healthcare consulting, revenue-cycle, claims-auditing, or payment-integrity experience, and an active nationally recognized coding or healthcare-compliance credential; preferred qualifications include healthcare-reimbursement and coding experience, forensic analytics, data-analysis tools, and electronic health-record software.
