Solventum HIS Clinical Analyst - Outpatient Methodology Groupers

Benefits

Additional Information

Thank you for your interest in joining Solventum. 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: https://www.solventum.com/en-us/home/legal/website-privacy-statement/applicant-privacy/ 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. Job Description: Job Title: Solventum HIS Clinical Analyst 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. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you. 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

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at Solventum (3M Healthcare)? Share your experience