Forensic Accountant - Healthcare
We are seeking an experienced
Forensic Accountant to join our Healthcare practice. In this role, you will investigate complex financial matters within healthcare organizations-including hospitals, physician groups, payers, and life sciences companies-and translate your findings into clear, defensible analysis that supports litigation, regulatory inquiries, and dispute resolution.
The ideal candidate combines deep healthcare financial expertise with hands-on litigation experience and a working command of modern AI and large language model (LLM) tools used to accelerate document review, data analysis, and reporting. You will work closely with attorneys, expert witnesses, compliance teams, and clients to reconstruct financial events, quantify damages, and uncover irregularities.
Key Responsibilities
- Conduct forensic investigations into healthcare billing, coding, reimbursement, revenue cycle, and cost-reporting matters, including potential fraud, waste, and abuse.
- Analyze large, complex financial and claims datasets to identify anomalies, quantify damages, and reconstruct transactions.
- Support litigation and dispute matters, including preparing schedules, exhibits, and expert report content, and assisting with deposition and trial preparation.
- Investigate allegations involving False Claims Act, Stark Law, Anti-Kickback Statute, payer/provider disputes, M&A disputes, and contractual underpayment or overpayment.
- Apply AI/LLM tools to accelerate document review, summarize evidence, draft work product, and surface patterns across unstructured records-while validating outputs for accuracy and defensibility.
- Interpret healthcare contracts, fee schedules, and reimbursement methodologies (e.g., DRG, RVU, fee-for-service, capitation, value-based arrangements).
- Prepare clear written reports and findings suitable for counsel, regulators, and the courts.
- Collaborate with multidisciplinary teams of attorneys, data analysts, clinicians, and compliance professionals.
- Maintain meticulous documentation and chain-of-custody standards to ensure findings are evidence-based and admissible.
Required Qualifications
- Active CPA license (in good standing).
- Demonstrated healthcare industry experience, with working knowledge of healthcare billing, coding, reimbursement, and regulatory frameworks.
- Litigation experience, including supporting expert reports, damages calculations, depositions, and/or testimony in a forensic or dispute context.
- Hands-on experience with AI/LLM tools applied to financial analysis, document review, or investigative workflows.
- Strong analytical skills with the ability to work with large, complex, and unstructured datasets.
- Excellent written and verbal communication skills, including the ability to explain technical findings to non-technical audiences.
- High standard of professional integrity, objectivity, and attention to detail.
Preferred Qualifications
- Additional forensic or fraud credentials (e.g., CFE, CFF, ABV, MAFF).
- Experience with healthcare-specific data sources and claims systems (e.g., 837/835 EDI, CMS data, EHR/practice management exports).
- Familiarity with the False Claims Act, Stark Law, Anti-Kickback Statute, and HIPAA.
- Proficiency with data analytics and visualization tools (e.g., SQL, Python, Power BI, Tableau, Alteryx).
- Experience prompting, evaluating, and validating LLM outputs for accuracy, bias, and reliability in a professional setting.
- Prior experience in a public accounting, consulting, or expert-services environment.