Manager, Healthcare Forensics

BDO USA • Jacksonville, FL

6h • $95,000 - $160,000

About The Position

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.

Requirements

• 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
• 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
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity

Nice To Haves

• Proficiency in the use of Epic, preferred
• Additional certification applicable to this work such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar

Responsibilities

• 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

Benefits

• ESOP offers participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well-being.
• comprehensive compensation and Total Rewards benefits offerings

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED