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About the Role

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.

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
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

Requirements

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
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

Skills

Healthcare reimbursement
Coding
Payment integrity
Healthcare forensics
Litigation support
Disputes
Expert testimony
MS-DRGs
Inpatient billing practices
DRG assignment and validation
Medical necessity
Inpatient admission criteria
Coding accuracy
CMS and payer-specific guidelines
Bundling
Downcoding
Reimbursement methodologies
ICD-10-CM/PCS coding frameworks
Medicare IPPS rules
CMS regulatory guidance
Commercial payer reimbursement policies
Data-driven analyses
Hospital claims
Payment patterns
Coding outcomes
DRG validation findings
Inpatient billing practices
Medical necessity issues
Reimbursement impact
Theories of harm
Quantifiable, defensible analyses
Expert reports
Expert analyses
Presentations
Client deliverables
Cross-examination
Legal challenges
Counsel interaction
Health systems interaction
Payer interaction
Healthcare executives interaction
Analytics teams interaction
Internal stakeholders interaction
Privilege-aware environments
Deadline-driven litigation environments
Complex coding concepts
Complex reimbursement concepts
Complex medical necessity concepts
Complex data concepts
Complex regulatory concepts
Project management
Staffing
Workflow discipline
Quality control
Risk management
Margin/realization awareness
Business development
Proposal development
Client presentations
Expert positioning
Relationship building
Service offering identification
Market opportunities
Law firm relationships
Health system relationships
Payer relationships
Healthcare client relationships
Trusted advisor positioning
Industry trend monitoring
Legal development monitoring
Regulatory development monitoring
Coding guidance monitoring
Reimbursement guidance monitoring
Best practice implementation
Team collaboration
Accountability
Team focus
Data analytic tools
Claims analysis
DRG assignment analysis
Payment pattern analysis
Reimbursement analysis
Inpatient utilization analysis
Coding analysis
Documentation analysis
Medical necessity analysis
Payment integrity analysis
Improper transaction analysis
Analytical workflows
Sampling
Financial models
Expert report support
Expert presence
Composure
Clarity
Defensibility
Critical thinking
Problem-solving
Attention to detail
Repeatable methodologies
Analytical frameworks
Quality assurance processes
Commercial mindset
Team management
Multi-tasking
Independent work
Group environment work
Delivery focus
Balancing priorities
Distilling complex issues
Organizational skills
Meeting project deadlines
Maintaining workflow discipline
Interacting with diverse individuals
Building relationships
Encouraging collaboration
High-performing team environment
Professional development contribution
Proactive approach
Adaptability
Driving execution
Driving strategy

Experience Level

Ten (10) to fifteen (15) or more years of experience
Seasoned

Education Level

Bachelor’s degree, required
Advanced degree such as MD, RN, JD, MPH, MBA, MHA, or related healthcare, clinical, legal, or business degree, preferred
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

Salary/Compensations

National Range: $160,000 - $260,000
Maryland Range: $160,000 - $260,000
NYC/Long Island/Westchester Range: $160,000 - $260,000

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
Comprehensive compensation and Total Rewards benefits offerings

About the Company

At BDO, how we show up matters. We build strong relationships by supporting one another, our clients, and our communities with care, curiosity, and a commitment to helping one another grow and succeed. Here, you’ll find meaningful work, leaders invested in your success, and opportunities to build a career around what matters most to you.
Our purpose is to be the people our clients count on to grow with confidence and achieve what matters most. Our values guide how we bring that purpose to life each day. Together, they shape how we work with one another, serve our clients, and create meaningful impact.
BDO provides assurance, tax, and advisory services to clients across the U.S. and around the world. No matter your role, you’ll be part of a team helping clients navigate complexity and move forward with clarity.
We are proud to be an ESOP company, offering participants a stake in the firm’s success through beneficial ownership and a unique opportunity to enhance their financial well-being. As a qualified retirement plan, the ESOP is a meaningful addition to our comprehensive compensation and Total Rewards benefits* offerings. It also reinforces an ownership mindset that strengthens our connection to one another, our clients, and the future we’re building together.

Equal Opportunity

Equal Opportunity Employer, including disability/vets