Solventum HIS Clinical Analyst – Population Health Methodology Groupers

Solventum is a new healthcare company with a long legacy of solving big challenges that improve lives and help healthcare professionals perform at their best. At Solventum, people are at the heart of every innovation we pursue. Guided by empathy, insight, and clinical intelligence, we collaborate with the best minds in healthcare to address our customers’ toughest challenges.

About the role

Solventum HIS is an international leader in designing and maintaining healthcare payment and quality outcome systems and 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.

In this role, you will serve as a hands-on clinical analyst, responsible for the design, development, and maintenance of several proprietary Solventum methodologies, including Clinical Risk Groups (CRGs), Patient Focused Episodes, and Potentially Preventable Returns to Hospital (PPRH). These methodologies utilize healthcare data, including diagnostic and procedural codes, for determining payment and quality in healthcare.

Responsibilities

• Perform in-depth validation and testing analysis of healthcare data to evaluate methodology behavior and identify anomalies and enhancements.
• Serve as a methodology expert, contributing to and coordinating with the Research team on efforts related to the methodologies, and 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 (e.g., ICD-10-CM, CPT, and HCPCS) and knowledge of healthcare revenue cycle and outpatient coding and billing.
• Collaborate cross-functionally while maintaining accountability with technical, quality, and clinical team members, integrating product concepts to develop software components for each methodology.
• Maintain process documentation for the methodologies, producing update summaries and other descriptive documents using C&ER standards and methods.

Requirements

• Bachelor’s degree or applicable certifications (completed and verified prior to start) from an accredited institution and 5+ years of experience in the healthcare industry in one or more of the following:
  • Healthcare services research and analytics
  • Outpatient medical coding and billing operations
  • Outpatient prior authorization or denials management
  • Outpatient healthcare claims and processing optimization
  • Payor claims design and edit management
• Ability to collaborate with cross-functional teams, including researchers, healthcare providers, and software engineers.
• Knowledge of ICD-10-CM, ICD-10-PCS, HCPCS/CPT, claims processing workflows, DRG classification, and reimbursement methodologies.
• Experience using Excel, databases, and other analytical software applications.
• Familiarity with the application of AI technologies for research, analytics, and process automation.
• Ability to communicate technical and clinical information to a variety of audiences, including concepts related to coding systems and patient classification methodologies.
• Experience managing multiple priorities and subject areas within a dynamic work environment.
• Experience working in multicultural and cross-functional environments while managing deadlines, priorities, and workload.
• Ability to work independently and collaboratively while assuming responsibility for assigned tasks and deliverables.
• Experience contributing to team-based initiatives and collaborative work efforts.
• Commitment to ethical business practices and professional standards.

Qualifications (Preferred)

• Master’s degree in a health field, clinical informatics, clinical coding, and/or HIM credentials.
• Enthusiastic collaborator who energizes and leads others.
• High integrity and work ethic.
• 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.
• Ability to effectively communicate ideas, concepts, and information, including presenting and training on clinical concepts, coding systems, and the underlying design of patient classification methodologies in healthcare.
• Familiarity with patient classification research and development, including:
  • Inpatient and outpatient coding and payment systems
  • Commercial, Medicare, and Medicaid environments
  • Risk adjustment
  • Medicare claims processing and data analysis
• Experience building payment and quality measures.
• Ability to evaluate research questions, analyze results and statistical output and patterns, and document hypotheses and recommendations.
• Healthcare software product development experience, bringing products from initial concept to release.
• Healthcare payer, delivery, or industry experience in healthcare quality, population health, or care management.

Schedule

Work location: Remote

Travel: May include up to 5%

Must be legally authorized to work in the country of employment without sponsorship for employment visa status (e.g., H1B status).

Benefits

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.

• Medical, Dental, and Vision coverage
• Health Savings Accounts
• Health Care and Dependent Care Flexible Spending Accounts
• Disability Benefits
• Life Insurance
• Voluntary Benefits
• Paid Absences
• Retirement Benefits

Additional information is available at: Solventum Total Rewards.

Pay

The expected compensation range for this position is $107,600 - $147,950, which includes base pay plus variable incentive pay, if eligible. The specific compensation offered to a candidate may vary based on factors including, but not limited to, the candidate’s relevant knowledge, training, skills, work location, and/or experience.

Onboarding

As part of the onboarding experience, you will have an opportunity to meet with your manager and other new employees during the Solventum new employee orientation. New employees hired for this position with a start date of October 1st, 2025, or later 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. (Applicable to US applicants only.)