Clinical Analyst – Population Health Methodology Groupers

This is a fully remote position, open to applicants in Connecticut.

📋 Description

• Create, develop, and sustain proprietary Solventum methodologies, such as Clinical Risk Groups, Patient Focused Episodes, and Potentially Preventable Returns to Hospital.

• Conduct thorough validation and testing analysis of healthcare data to assess methodology functionality and pinpoint anomalies and improvements.

• Act as a methodology expert and collaborate with the Research team on initiatives related to the methodologies.

• Provide input for prioritizing potential research for enhancements.

• Collaborate with the Chief Product Owner, Product Owners, and Development team to promote methodology upgrades.

• Convert clinical concepts into documented, actionable logic content specifications utilizing ICD-10-CM, CPT, and HCPCS coding systems.

• Leverage knowledge of healthcare revenue cycle and outpatient coding and billing.

• Work alongside technical, quality, and clinical team members to integrate product concepts and create software components.

• Ensure methodology process documentation is kept up to date.

• Generate update summaries and descriptive documents following C&ER standards and methods.

• Adhere to corporate policies, procedures, and security standards.

⛳️ Requirements

• Bachelor's degree or relevant certifications from an accredited institution, completed and verified before starting.

• Over 5 years of experience in the healthcare field, specifically in healthcare services research and analytics, outpatient medical coding and billing operations, outpatient prior authorization or denials management, outpatient healthcare claims processing optimization, or payor claims design and edit management.

• Capability to collaborate with cross-functional teams, including researchers, healthcare providers, and software engineers.

• Proficiency in ICD-10-CM, ICD-10-PCS, HCPCS/CPT, claims processing workflows, DRG classification, and reimbursement methodologies.

• Experience with Excel, databases, and other analytical software applications.

• Familiarity with AI technologies for research, analytics, and process automation.

• Ability to convey technical and clinical information to diverse audiences.

• Proven experience managing multiple priorities and subject areas in a fast-paced work environment.

• Experience in multicultural and cross-functional settings while managing deadlines, priorities, and workload.

• Ability to work independently and collaboratively, taking responsibility for assigned tasks and deliverables.

• Proven track record of contributing to team-based initiatives and collaborative efforts.

• Commitment to ethical business practices and professional standards.

• Must have legal authorization to work in the country of employment without requiring employment visa sponsorship.

• A Master's degree in a health-related field, clinical informatics, clinical coding, and/or HIM credentials is considered an additional qualification.

• Familiarity with inpatient and outpatient coding and payment systems, including commercial, Medicare, and Medicaid environments, risk adjustment, Medicare claims processing, and data analysis.

• Experience in developing payment and quality measures.

• Ability to evaluate research questions, analyze results and statistical outputs and patterns, and document hypotheses and recommendations.

• Background in healthcare software product development.

• Experience in healthcare payer, delivery, or industry roles related to healthcare quality, population health, or care management.

🏝️ Benefits

• Medical, Dental & Vision coverage.

• 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 mandatory on-site onboarding.

• Remote work options.

• Up to 5% travel required.