Solventum HIS Clinical Analyst – Outpatient Methodology Groupers

About the role

Solventum is an international leader in designing and maintaining healthcare payment and quality outcome systems, advancing value-based care. We work closely with Medicare, Medicaid, and commercial insurers on hospital, outpatient, and population payment models and design quality outcome programs that promote patient safety and reduce avoidable costs. We also support more than ten countries on how they budget and pay for inpatient and outpatient care, and measure healthcare quality.

Responsibilities

• Serve as a hands-on clinical analyst, responsible for the design, development, and maintenance of Solventum’s outpatient public and proprietary methodologies, code editors, and software including Tricare, Home Health, IOCE (Integrated Outpatient Code Editor), and EAPG (Enhanced Ambulatory Payment Grouper).
• Perform in-depth validation and testing analysis of healthcare data to evaluate methodology behavior and identify anomalies and enhancements.
• Contribute and coordinate with the Research team efforts related to the methodologies, providing input into the prioritization of potential research for enhancements.
• Work directly with the Chief Product Owner, Product Owners, and Development team to drive enhancements to the methodologies by translating clinical concepts into clearly documented, executable logic content specifications using existing coding systems (ICD-10-CM, CPT, and HCPCS) and knowledge of healthcare revenue cycle and outpatient coding and billing.
• Collaborate cross-functionally while maintaining accountability with the technical, quality, and clinical team members, integrating product concepts to develop software components for each methodology.
• Maintain process documentation for the methodologies, produce update summaries and other descriptive documents using C&ER standards and methods.

Requirements

• Bachelor or higher (completed and verified prior to start) from an accredited institution AND 5+ years’ experience in the healthcare industry in one or more of the following: outpatient medical coding and billing operations, outpatient prior authorization or denials management, outpatient healthcare claims and processing optimization, payor claims design and edit management, and outpatient healthcare services research and analytics.
• Strong expertise in HCPCS/CPT, ICD-10-CM, and standard claims processing, with additional proficiency in ICD-10-PCS, APC, and DRG classification and reimbursement methodologies.
• Significant experience working with Excel, databases, and ability to learn computer applications for analysis.
• High integrity and work ethic are expected and highly valued.
• Familiarity with use of AI for research, analytics, and automation of processes.

Qualifications

• Master's degree in health field, clinical informatics, clinical coding, and/or HIM credentials.
• Enthusiastic collaborator that energizes and leads others.
• Ability to take individual initiative and responsibility for assignments while working independently and in a team environment.
• Comfortable in a multicultural, complex, cross-functional, and dynamic work environment, able to prioritize, multi-task, focus on goals, take accountability, and manage time well.
• Demonstrated ability to effectively manage frequent context switching across multiple priorities and subject areas within a dynamic work environment.
• The ability to effectively communicate ideas, concepts, and information: presenting and training clinical concepts, coding systems, and underlying design of patient classification methodologies in healthcare.
• The ability to collaborate with a diverse professional team including researchers, healthcare providers, and engineers.
• Familiarity with patient classification research and development: outpatient coding and payment systems, commercial, Medicare, and Medicaid environments, risk adjustment, Medicare Claims processing and data analysis, experience building payment and quality measures.
• Healthcare software product development experience, bringing products from initial concept to release.
• Healthcare payer, delivery, or industry experience in healthcare quality, population health, care management.

Skills

• Strong expertise in HCPCS/CPT, ICD-10-CM, and standard claims processing, with additional proficiency in ICD-10-PCS, APC, and DRG classification and reimbursement methodologies.
• Significant experience working with Excel, databases, and ability to learn computer applications for analysis.
• High integrity and work ethic are expected and highly valued.
• Familiarity with use of AI for research, analytics, and automation of processes.

Benefits

Supporting Your Well-being
Solventum offers many programs to help you live your best life – both physically and financially. To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope. Onboarding Requirement: To improve the onboarding experience, you will have an opportunity to meet with your manager and other new employees as part of the Solventum new employee orientation. As a result, new employees hired for this position will be required to travel to a designated company location for on-site onboarding during their initial days of employment. Travel arrangements and related expenses will be coordinated and paid for by the company in accordance with its travel policy.

Pay

$96,000 - $132,000, which includes base pay plus variable incentive pay, if eligible.

Schedule

Remote

Benefits

Additional information is available at: https://www.solventum.com/en-us/home/our-company/careers/#Total-Rewards