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. While we continue updating the Solventum Careers Page and applicant materials, some documents may still reflect legacy branding.

Please note that all listed roles are Solventum positions, and our Privacy Policy:  applies to any personal information you submit. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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 make an impact by:
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). 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.

Be responsible for maintaining process documentation for the methodologies, producing update summaries and other descriptive documents using C&ER standards and methods.

To set you up for success in this role from day one, Solventum requires (at a minimum) the following 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. AND In addition to the above requirements, the following are also required:
Ability to collaborate with cross-functional teams,…