Clinical Analyst

4 weeks ago

Meriden, Connecticut, United States Solventum Full time
Join Solventum's Team as a Clinical Analyst

Solventum is a leading company in designing and maintaining healthcare payment systems. We support more than ten countries in budgeting and paying for inpatient and outpatient care. As a Clinical Analyst, you will play a vital role in the equitable financing of healthcare globally.

The Impact You'll Make
  • Assume primary responsibility for Clinical Analyst in providing subject matter expertise in clinical content development, specification, documentation, validation, and application of software modules related to Medicare Severity Diagnosis Related Groupers (MS-DRGs), TriCare, and maintaining specifications of the map and any related mapping for variables required for the methodology, holding to standards and best practices.
  • Align the discipline of inpatient patient classification, inpatient payment, regulatory update processes, demonstrating underlying clinical concepts to various state/federal agencies, hospitals, and/or organizations.
  • Work directly with the Chief Product Owner, Product Owners, Research team, and government agencies to drive enhancements to the methodologies by reviewing proposed suggested changes, defining evaluation approach and specifications, review of results, and proposal of recommendations towards updates to clinical MS-DRG logic that include clear clinical logic specifications using existing coding system definitions.
  • Work directly and collaborate with the technical, quality, and clinical team members, integrating product concepts to implement and test the clinical specification.
  • Responsible for maintaining process documentation for the MS-DRG, TriCare, update using C&ER standards and methods.
Your Skills and Expertise
  • Bachelor's Degree or higher AND (4) years of job-related experience OR High School Diploma/GED from AND (8) years of the same job-related experience.
  • Additional qualifications that could help you succeed in this role include:
    • Master's degree in a related field, clinical informatics, coding, and/or HIM credentials.
    • Strong knowledge of patient classification research and development: outpatient payment and risk adjustment, efficiency measures, commercial, Medicare, and Medicaid environments, in-depth knowledge of ICD-10 CM/PCS diagnosis and procedure codes, awareness of ICD-11.
    • Experience with healthcare data, coding, billing, editing, and payment, particularly for patient claims and HIPAA requirements.
    • Experience with review and analysis of federal and state regulatory documentation related to healthcare claim processing and payment as well as understanding of the CMS rule-making process for patient payment.
    • Ability to evaluate a research question, define analysis, analyze results, and statistical output and patterns, document hypotheses and recommendations.
    • Software development experience, bringing products from initial concept to release.
    • Ability to effectively communicate ideas, concepts, and information: presenting and training of clinical concepts, coding systems, and underlying design of patient classification methodologies in healthcare.
    • Comfortable in a multicultural, complex, cross-functional, and dynamic work environment, able to prioritize, multi-task, focus on goals, take accountability, and manage time well.
    • Ability to take individual initiative and responsibility for assignments while working independently and in a team environment.
    • Passionate, team player that energizes and leads others.
    • High integrity and work ethic are expected and highly valued.
Work Location and Benefits
  • Remote work location.
  • No travel required.
  • No relocation assistance.
  • Must be legally authorized to work in the country of employment without sponsorship for employment visa status.

Solventum offers many programs to help you live your best life – both physically and financially. To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope.

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