Solventum HIS Clinical Analyst - Outpatient Methodology Groupers

Job Title Solventum HIS Clinical Analyst Equal Employment Opportunity Solventum will not discriminate against any applicant for employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Description Solventum HIS is an international leader in designing and maintaining healthcare payment and quality outcome systems. You will make an impact by: Serve as a hands‑on clinical analyst, responsible for design, development and maintenance of Solventum outpatient public and proprietary methodologies, code editors, and software including Tricare, Home Health, IOCE, and EAPG. 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 to prioritize research for enhancements. Work directly with the Chief Product Owner, Product Owners, and Development team to drive enhancements to the methodologies by translating clinical concepts into documented, executable logic specifications using coding systems (ICD‑10‑CM, CPT, HCPCS). Collaborate cross‑functionally with technical, quality, and clinical team members to integrate product concepts in software components for each methodology. Maintain process documentation for the methodologies, producing update summaries and other descriptive documents using C&ER standards and methods. Qualifications Minimum qualifications: Bachelor’s degree or higher (verified prior to start) plus 5+ years’ experience in the healthcare industry in outpatient medical coding and billing operations, outpatient prior authorization or denials management, outpatient healthcare claims and processing optimization, payor claims design and edit management, or outpatient healthcare services research and analytics. 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 strong work ethic. Familiarity with the use of AI for research, analytics and automation of processes. Additional qualifications (optional): Master’s degree in health field, clinical informatics, clinical coding, and/or HIM credentials. Enthusiastic collaborator that energizes and leads others. Ability to take individual initiative and responsibility for assignments while working independently and in a team environment. Comfortable in a multicultural, complex, cross‑functional, dynamic work environment, able to prioritize, multi‑task, focus on goals, take accountability, and manage time well. Demonstrated ability to manage frequent context switching across multiple priorities and subject areas. Excellent communication skills for presenting clinical concepts, coding systems, and design of patient classification methodologies. Ability to collaborate with researchers, healthcare providers, and engineers. Familiarity with patient classification research and development, including 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, document hypotheses, and recommend improvements. Healthcare software product development experience, bringing products from initial concept to release. Experience in healthcare payer, delivery or industry experience in quality, population health, care management. Work Location Remote Travel May include up to 5% Relocation Assistance Not authorized Legal Requirements Must be legally authorized to work in the country of employment without sponsorship for employment visa status (e.g. H1B). Solventum will not discriminate against any applicant. Compensation The expected compensation range for this position is $96,000 - $132,000, which includes base pay plus variable incentive pay, if eligible. The 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. This position may be eligible for a range of benefits (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.). #J-18808-Ljbffr Santa Barbara Cottage Hospital