[Hiring] Clinical Analyst @SOLVENTUM

Role Description

At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers’ toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best.

The Impact You Will Make in this Role:

• Serve as a hands-on clinical analyst, responsible for the design, development and maintenance of several proprietary Solventum methodologies to include Clinical Risk Groups (CRGs) and Patient Focused Episodes population health focused methodologies and Potentially Preventable Returns to Hospital (PPRH).
• Perform in-depth validation and testing analysis of healthcare data to evaluate methodology behavior and identify anomalies and enhancements.
• Serve as methodology expert contributing and coordinating with the Research team efforts related to the methodologies, provide input into the prioritization of the potential research for enhancements.
• Work directly with the Chief Product Owner, Product Owners, and Development team to drive enhancements to the methodologies by translating the clinical concepts into clearly documented, executable logic content specifications using existing coding systems (i.e., 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.
• Responsible for maintaining process documentation for the methodologies, producing update summaries and other descriptive documents using C&ER standards and methods.

Qualifications

• Bachelor or applicable certifications (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: healthcare services research and analytics, outpatient medical coding and billing operations, outpatient prior authorization or denials management, outpatient healthcare claims and processing optimization, and/or 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.

Requirements

• Master's degree in health field, clinical informatics, clinical coding, and/or HIM credentials.
• Enthusiastic collaborator that energizes and leads others.
• High integrity and work ethic are expected and highly valued.
• 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.
• An 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:
• 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, care management.

Benefits

• Competitive pay and benefits.
• Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits.

Work Location

• Remote.
• Travel: May include up to 5%.
• Relocation Assistance: Not authorized.
• Must be legally authorized to work in country of employment without sponsorship for employment visa status (e.g., H1B status).