Clinical Analyst – Population Health Methodology Groupers

🕒 5 dias atrás

🦌 Connecticut – Remoto

🦌 Connecticut – Remote

💵 $107.600 - $147.950 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

👻 Score fantasma 0%

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Solventum

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

📦 Logística

💼 Consultoria

Healthcare • Logistics • Consulting

Solventum é uma empresa focada em saúde, conhecida por suas soluções inovadoras voltadas para melhorar os resultados dos cuidados médicos e odontológicos. A empresa oferece uma variedade de tecnologias médicas, incluindo cuidados avançados para feridas, soluções cirúrgicas e produtos de esterilização. A Solventum também fornece soluções avançadas para cuidados orais, serviços de tecnologia e informação em saúde, e produtos de purificação e filtração para aplicações biofarmacêuticas. Além disso, a Solventum dá forte ênfase à sustentabilidade e educação, oferecendo recursos e treinamento para profissionais de saúde em todo o mundo. Seu compromisso com a inovação e com a melhoria da saúde fez dela uma líder na indústria de saúde, dedicada a aprimorar a segurança dos pacientes e a eficiência dos cuidados médicos.

Descrição

• Design, develop, and maintain proprietary Solventum methodologies, including Clinical Risk Groups, Patient Focused Episodes, and Potentially Preventable Returns to Hospital • Perform in-depth validation and testing analysis of healthcare data to evaluate methodology behavior and identify anomalies and enhancements • Serve as methodology expert and coordinate with Research team efforts related to the methodologies • Contribute input to prioritization of potential research for enhancements • Work with the Chief Product Owner, Product Owners, and Development team to drive methodology enhancements • Translate clinical concepts into documented, executable logic content specifications using ICD-10-CM, CPT, and HCPCS coding systems • Apply knowledge of healthcare revenue cycle and outpatient coding and billing • Collaborate with technical, quality, and clinical team members to integrate product concepts and develop software components • Maintain methodology process documentation • Produce update summaries and descriptive documents using C&ER standards and methods • Comply with corporate policies, procedures, and security standards

🎯 Requisitos

• Bachelor's degree or applicable certifications from an accredited institution, completed and verified prior to start • 5+ years’ experience in the healthcare industry in 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 AI technologies for research, analytics, and process automation • Ability to communicate technical and clinical information to varied audiences • Experience managing multiple priorities and subject areas in 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 • Must be legally authorized to work in the country of employment without employment visa sponsorship • Master's degree in a health field, clinical informatics, clinical coding, and/or HIM credentials is an additional qualification • Familiarity with 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 • Healthcare payer, delivery, or industry experience in healthcare quality, population health, or care management

🏖️ Benefícios

• Medical, Dental & Vision • Health Savings Accounts • Health Care & Dependent Care Flexible Spending Accounts • Disability Benefits • Life Insurance • Voluntary Benefits • Paid Absences • Retirement Benefits • Company-paid travel arrangements and related expenses for required on-site onboarding • Remote work • Up to 5% travel