Healthcare Expert TestifierBDO 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.
Job Duties:
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
Supervisory Responsibilities:
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 Qualifications, Knowledge, Skills, and Abilities: Education Bachelor's degree, required Advanced degree such as MD, RN, JD, MPH, MBA, MHA, or related healthcare, clinical, legal, or business degree, preferred ExperienceTen (10) to fifteen (15) or more years of experience in healthcare reimbursement, coding, payment integrity, healthcare forensics, litigation support, disputes, or related advisory services, requiredDemonstrated 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, requiredStrong understanding of CMS regulations and guidance, including IPPS rules, Medicare claims processing, medical necessity, inpatient admission criteria, and commercial payer policies affecting inpatient reimbursement, requiredExperience leading complex, data-intensive engagements and working with analytics teams to ensure methodologies, samples, findings, and workpapers are defensible and reproducible, requiredProven ability to author expert reports, develop expert opinions, communicate with counsel, and withstand cross-examination or other legal challenges, requiredProven experience managing complex projects, cross-functional teams, and multiple priorities in fast-paced, deadline-driven litigation or consulting environments, requiredDemonstrated ability to delegate effectively, provide quality control, and develop junior staff within a leveraged consulting model, requiredStrong written and verbal communication skills, including client-facing deliverables, expert reports, testimony, and presentations, required Prior experience with litigation consulting firms, healthcare disputes groups, expert witness practices, payment integrity organizations, DRG audit vendors, health systems, payers, or advisory practices, preferredExperience 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, preferredExperience supervising and developing high-performing consulting teams, coders, analysts, and other professionals, preferred License/Certification Professional coding or health information certification such as CCS, CPC, RHIT, RHIA, or similar credential, required Additional clinical, healthcare compliance, fraud examination, data analytics, accounting, reimbursement, or project management credentials, preferred SoftwareProficient in Microsoft Excel, Word, and PowerPoint, requiredExperience leveraging data analytic tools to analyze claims, DRG assignment, payment patterns, reimbursement, inpatient utilization, coding, documentation, medical necessity, payment integrity, and potentially improper transactions, preferredExperience overseeing large-scale data analyses, analytical workflows, sampling, financial models, and expert report support, preferred LanguageN/AOther Knowledge, Skills & Abilities 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
