Manager, Healthcare Forensics – Healthcare Revenue Cycle

Job Summary:

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.

Job Duties:

• 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

Supervisory Responsibilities:

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

Qualifications, Knowledge, Skills, and Abilities:

Education:

• 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

Experience:

• 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

License(s)/Certification(s)/Affiliation(s):

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

Software:

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

Other Knowledge, Skills & Abilities:

• 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. BDO professionals provide assurance, tax and advisory services for a diverse range of clients across the U.S. and in over 160 countries through our global organization.

BDO is the first large accounting and advisory organization to implement an Employee Stock Ownership Plan (ESOP). A qualified retirement plan, the ESOP offers participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well-being. The ESOP stands as a compelling addition to our comprehensive compensation and Total Rewards benefits* offerings. The annual allocation to the ESOP is fully funded by BDO through investments in company stock and grants employees the chance to grow their wealth over time as their shares vest and grow in value with the firm’s success, with no employee contributions.

We are committed to delivering exceptional experiences to middle market leaders by sharing insight-driven perspectives, helping companies take business as usual to better than usual. With industry knowledge and experience, a breadth and depth of resources, and unwavering commitment to quality, we pride ourselves on:

• Welcoming diverse perspectives and understanding the experience of our professionals and clients
• Empowering team members to explore their full potential
• Our talented team who brings varying skills, knowledge and experience to proactively help our clients navigate an expanding array of complex challenges and opportunities
• Celebrating ingenuity and innovation to transform our business and help our clients transform theirs
• Focus on resilience and sustainability to positively impact our people, clients, and communities
• BDO Total Rewards that encompass so much more than traditional “benefits.” Click here to find out more!
• Benefits may be subject to eligibility requirements.

Equal Opportunity Employer, including disability/vets

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