Clinical Analyst – Population Health Methodology Groupers

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $107.6k - $147.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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Solventum

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📦 Logistics

💼 Consulting

Healthcare • Logistics • Consulting

Solventum is a healthcare-focused company renowned for its innovative solutions aimed at improving medical and oral care outcomes. The company offers a variety of medical technologies, including advanced wound care, surgical solutions, and sterilization products. Solventum also provides advanced oral care solutions, health information and technology services, and purification and filtration products for biopharmaceutical applications. Furthermore, Solventum places a strong emphasis on sustainability and education, providing resources and training for healthcare professionals globally. Their commitment to innovation and better healthcare has made them a leader in the healthcare industry, dedicated to enhancing patient safety and healthcare efficiencies.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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