Director, Forensics Healthcare

BDO USA, P.C. • New York, NY

16h • $160,000 - $260,000

About The Position

BDO is seeking a seasoned healthcare expert testifier to join its rapidly growing Healthcare Forensics practice. This individual will play a critical leadership role in high-stakes healthcare litigation, arbitration, and payer/provider disputes, with a particular focus on hospital/inpatient reimbursement, DRG coding, and payment integrity. The ideal candidate brings a proven track record of expert testimony, deep subject matter expertise in Medicare Severity Diagnosis-Related Groups (MS-DRGs) and inpatient billing practices, and the ability to lead complex engagements while developing junior staff in a highly leveraged consulting model. This role is central to supporting BDO’s continued expansion in large-scale disputes where clinical, coding, and financial issues intersect.

Requirements

• Bachelor’s degree, required
• Ten (10) to fifteen (15) or more years of experience in healthcare reimbursement, coding, payment integrity, healthcare forensics, litigation support, disputes, or related advisory services, required
• Demonstrated experience serving as a testifying expert in healthcare litigation, arbitration, disputes, or related proceedings, including deposition, trial, arbitration, or expert report experience, required
• Deep expertise in hospital inpatient reimbursement systems, MS-DRGs, DRG validation audits, ICD-10-CM/PCS coding standards, inpatient billing practices, coding compliance frameworks, and reimbursement impact analysis, required
• Strong understanding of CMS regulations and guidance, including IPPS rules, Medicare claims processing, medical necessity, inpatient admission criteria, and commercial payer policies affecting inpatient reimbursement, required
• Experience leading complex, data-intensive engagements and working with analytics teams to ensure methodologies, samples, findings, and workpapers are defensible and reproducible, required
• Proven ability to author expert reports, develop expert opinions, communicate with counsel, and withstand cross-examination or other legal challenges, required
• Proven experience managing complex projects, cross-functional teams, and multiple priorities in fast-paced, deadline-driven litigation or consulting environments, required
• Demonstrated ability to delegate effectively, provide quality control, and develop junior staff within a leveraged consulting model, required
• Strong written and verbal communication skills, including client-facing deliverables, expert reports, testimony, and presentations, required
• Professional coding or health information certification such as CCS, CPC, RHIT, RHIA, or similar credential, required
• Proficient in Microsoft Excel, Word, and PowerPoint, required
• Credible expert presence with the ability to command authority in legal settings while maintaining composure, clarity, and defensibility under challenge
• Ability to identify opportunities for new engagements and expand existing service offerings
• Strong project management and engagement leadership skills, including the ability to lead complex workstreams from scope through delivery
• Strong analytical, critical thinking, writing, presentation, and problem-solving skills with exceptional attention to detail
• Ability to simplify complex technical issues involving DRG coding, inpatient reimbursement, medical necessity, CMS guidance, payer policy, data analytics, and regulatory requirements for legal and executive audiences
• Ability to build repeatable methodologies, analytical frameworks, quality assurance processes, and defensible approaches that can be taught and scaled
• Strong business development and commercial mindset through relationships, proposal development, client presentations, expert positioning, account expansion, staffing efficiency, and realization discipline
• Strong leadership and team management capability within a leveraged consulting environment, including the ability to delegate effectively and develop junior staff
• Self-starter with the ability to multi-task while working independently or within a group environment
• Strong delivery focus with the ability to balance multiple priorities in a fast-paced, deadline-driven environment with overlapping deadlines
• Excellent verbal and written communication skills, including the ability to distill complex issues for diverse audiences
• Solid organizational skills with the ability to meet project deadlines and maintain workflow discipline across concurrent engagements
• Ability to interact effectively with people at all organizational levels of the firm, clients, counsel, healthcare executives, and other stakeholders
• Capacity to build and maintain strong relationships with internal and client personnel
• Ability to encourage a collaborative, accountable, and high-performing team environment and contribute to the professional development of assigned personnel
• Proactive, adaptable, and capable of driving both execution and strategy

Nice To Haves

• Advanced degree such as MD, RN, JD, MPH, MBA, MHA, or related healthcare, clinical, legal, or business degree, preferred
• Prior experience with litigation consulting firms, healthcare disputes groups, expert witness practices, payment integrity organizations, DRG audit vendors, health systems, payers, or advisory practices, preferred
• Experience with large-scale provider/payer disputes, DRG validation, coding audits, medical necessity disputes, reimbursement disputes, denial/appeal mechanics, and inpatient claims analyses, preferred
• Existing relationships with law firms, health systems, payers, or healthcare clients and demonstrated ability to support business development, expert positioning, client presentations, and proposal efforts, preferred
• Experience supervising and developing high-performing consulting teams, coders, analysts, and other professionals, preferred
• Additional clinical, healthcare compliance, fraud examination, data analytics, accounting, reimbursement, or project management credentials, preferred
• Experience leveraging data analytic tools to analyze claims, DRG assignment, payment patterns, reimbursement, inpatient utilization, coding, documentation, medical necessity, payment integrity, and potentially improper transactions, preferred
• Experience overseeing large-scale data analyses, analytical workflows, sampling, financial models, and expert report support, preferred

Responsibilities

• Serves as a testifying expert in healthcare litigation matters, including depositions, trial testimony, arbitration proceedings, and other dispute forums
• Develops and defends expert opinions related to DRG assignment and validation, medical necessity and inpatient admission criteria, coding accuracy, CMS and payer-specific guidelines, bundling, downcoding, reimbursement methodologies, and payment integrity
• Leads end-to-end engagement delivery for healthcare litigation, arbitration, payer/provider disputes, forensic, reimbursement, payment integrity, compliance, and operational consulting engagements
• Develops engagement scope, analytical approach, methodologies, data requirements, analysis design, quality control processes, and report preparation workplans
• Provides subject matter leadership on MS-DRG classification systems, grouper logic, ICD-10-CM/PCS coding frameworks, Medicare IPPS rules, CMS regulatory guidance, and commercial payer reimbursement policies impacting inpatient claims
• Oversees large-scale data-driven analyses of hospital claims, payment patterns, coding outcomes, DRG validation findings, inpatient billing practices, medical necessity issues, and reimbursement impact
• Evaluates and develops methodologies to assess theories of harm in payer/provider disputes and translates coding, clinical, and reimbursement issues into quantifiable, defensible analyses
• Authors and supports clear, defensible expert reports, expert analyses, presentations, and client deliverables, and prepares to withstand cross-examination or other legal challenges
• Works closely with counsel, health systems, payers, healthcare executives, analytics teams, and internal stakeholders in privilege-aware, deadline-driven litigation environments
• Simplifies complex coding, reimbursement, medical necessity, data, and regulatory concepts for legal counsel, executives, triers of fact, and other non-technical audiences
• Manages multiple concurrent engagements with tight and overlapping deadlines, including staffing, workflow discipline, quality control, risk management, and margin/realization awareness
• Collaborates with leadership on business development efforts, including proposal development, client presentations, expert positioning, expansion of existing relationships, identification of new service offerings, and market opportunities
• Builds and maintains relationships with law firms, health systems, payers, and other healthcare clients, and supports BDO’s positioning as a trusted advisor in healthcare disputes, forensic analysis, and expert testimony
• Monitors and implements industry trends, legal and regulatory developments, coding and reimbursement guidance, and best practices; creates a positive, collaborative, accountable, and team-focused environment
• Other duties as required
• Supervises projects, often multiple concurrent projects, in healthcare litigation, arbitration, forensic, reimbursement, DRG validation, payment integrity, compliance, and operational consulting engagements
• Operates within BDO’s leveraged delivery model by effectively assigning, delegating to, managing, coaching, and developing Managers, Senior Associates, and Associates
• Provides technical oversight and quality control across engagement teams, including review of coding analyses, reimbursement methodologies, data-driven findings, expert report support, and client deliverables
• Mentors and trains junior staff on coding and reimbursement fundamentals, DRG/inpatient concepts, analytical methodologies, litigation support best practices, report support, documentation, and defensible work product development
• Acts as Career Advisor to Managers, Senior Associates, and Associates, providing ongoing coaching, performance feedback, and career development support
• Evaluates the performance of Managers, Senior Associates, and Associates and assists in the development of goals and objectives to enhance professional development

Benefits

• BDO Total Rewards encompass more than traditional benefits.
• ESOP company, offering participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well-being.
• Qualified retirement plan

What This Job Offers

• Job Type: Full-time
• Career Level: Director