Job Description:

Job Title:Solventum HIS Clinical Analyst

The Impact You Will Make in this 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. Here, you will make an impact by:

• Serve as a hands-on clinical analyst, responsible for the design, development and maintenance of the Solventum outpatient public and proprietary methodologies, code editors, and software including Tricare, Home Health, IOCE (Integrated Outpatient Code Editor), and EAPG (Enhanced Ambulatory Payment Grouper). These methodologies utilize healthcare data including diagnostic and procedural codes for determining payment and quality in healthcare.
• 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.

Your Skills and Expertise
To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications:

• 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.

AND

In addition to the above requirements, the following are also required:

• 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.

Additional qualifications that could help you succeed even further in this role include:

• 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:
  • 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

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).

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. Applies to new hires with a start date of October 1st 2025 or later.

Applicable to US Applicants Only:The expected compensation range for this position is $96,000 - $132,000, which includes base pay plus variable incentive pay, if eligible. This range represents a good faith estimate for this position. 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. In addition, this position may be eligible for a range of benefits (e.g., Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits, etc.). Additional information is available at: https://www.solventum.com/en-us/home/our-company/careers/#Total-Rewards

Responsibilities of this position include that corporate policies, procedures and security standards are complied with while performing assigned duties.

Solventum is committed to maintaining the highest standards of integrity and professionalism in our recruitment process. Applicants must remain alert to fraudulent job postings and recruitment schemes that falsely claim to represent Solventum and seek to exploit job seekers.

Please note that all email communications from Solventum regarding job opportunities with the company will be from an email with a domain of @solventum.com. Be wary of unsolicited emails or messages regarding Solventum job opportunities from emails with other email domains.

Please note, Solventum does not expect candidates in this position to perform work in the unincorporated areas of Los Angeles County.

Please note: your application may not be considered if you do not provide your education and work history, either by: 1) uploading a resume, or 2) entering the information into the application fields directly.