Healthcare Fraud, Financial Crime, Compliance & Investigative Services Consulting

Job Family:

Forensic Accounting Consulting

Travel Required:

Up to 50%

Clearance Required:

None

What You Will Do:

Guidehouse has an aggressive growth strategy for its Healthcare Fraud, Financial Crime, Compliance, and Investigative Services (FFI-Health) team. FFI-Health is currently seeking candidates with relevant healthcare fraud, waste, and abuse (FWA), regulatory compliance, and/or investigations experience (e.g., litigation and/or disputes consulting, forensic accounting, operational and/or compliance consulting) or relevant healthcare operations management experience with any of the following: healthcare providers, payers, life sciences companies, law firms, public health agencies, and/or regulators/enforcement agencies.

Responsibilities include the following:

• Assist with healthcare and life sciences compliance, investigations, and risk consulting engagements across healthcare providers, payers, life sciences companies, public health agencies, and/or regulatory/government.
• Provide support for fraud and/or bribery and corruption investigations.
• Assist in the development and production of reports, presentations, analyses, memos, and other client deliverables.
• Query and analyze healthcare datasets.
• Analyze and interpret historical healthcare data related to claims, reimbursement, financial, clinical, and/or operations to identify risks, compliance issues, and indicators of FWA.
• Excellent presentation skills.
• Flexibility with respect to assigned tasks and engagements due to challenging deadlines, changing deliverables, and evolving task priorities.
• Strong work ethic, eagerness to learn, and motivation to succeed.

What You Will Need:

• A Bachelor’s degree from an accredited college/university.
• Minimum 5 years of consulting or in-house experience working on matters related to healthcare fraud, regulatory compliance, or investigations and/or relevant health care operations management with/at any of the following: healthcare providers, payers, life sciences companies, public health agencies, or regulatory/government (DOJ, OIG etc.).
• General understanding of healthcare provider, payer, life sciences, and/or public health regulations, standards, fraud, waste, and abuse schemes, enforcement activities, and anti-corruption best practices.
• General understanding of concepts regarding healthcare and life sciences investigations, compliance, audit, risk, quality, and data analytics across Medicare, Medicaid, and State and Federal regulatory programs and/or forensic accounting.
• Report writing and deliverables preparation experience.
• Proficiency in MS PowerPoint, MS Word, and MS Excel.
• Ability to apply qualitative and quantitative skills to various engagements.
• Must be willing to travel. Travel requirements vary based on project and client needs.
• Able and willing to relocate to the New York City (NYC) or Washington D.C. area at own expense if not currently based there.
• Able and willing to come into Guidehouse’s NYC or D.C. office 3 days per week for internal meetings and work at clients’ locations when required.

What Would Be Nice to Have:

• Experience with Corporate Integrity Agreements.
• Experience with compliance program reviews and/or development and implementation for payers, providers and/or life science companies.
• Experience with internal investigations of fraud and/or bribery and corruption for public health agencies, payers, providers, and/or life science companies.
• Experience with Medicare and Medicaid program rules and regulations.
• Understanding of healthcare reimbursement and coding.
• Understanding of OIG and DOJ Compliance Program Guidance for Healthcare Entities.
• Intermediate experience with developing data visualizations using Tableau, PowerBI, Excel.
• Experience working at two or more of the following: public health agency, payers, providers, life sciences company, regulator, or enforcement agency.
• Familiarity with case management tools.
• Certified Fraud Examiner (CFE) or forensic accounting/financial investigations background.
• Experience with relational database and analytics programs (e.g., SQL, Access, Python, R, Snowflake).

The annual salary range for this position is $109,100.00-$163,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave and Adoption Assistance
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Student Loan PayDown
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program
• Mobility Stipend

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

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