Solventum HIS Clinical Analyst – Outpatient Methodology Groupers
$96,000–$132,000 year
Remote · Connecticut, United States
Job Summary
Solventum Solventum HIS Clinical Analyst – Outpatient Methodology Groupers: A hands-on clinical analyst responsible for design, development and maintenance of outpatient methodologies (e.g., Tricare, Home Health, IOCE, EAPG) and associated code editors. Validate healthcare data to evaluate methodology behavior, identify anomalies, and prepare executable logic specifications using ICD-10-CM, CPT, and HCPCS. Collaborate with Research, Product Owners, and Development to translate clinical concepts into documented, executable content; maintain process documentation and update summaries per C&ER standards. Requires strong outpatient coding/billing experience, knowledge of revenue-cycle and outpatient coding and billing, and comfort working in a remote, cross-functional environment.
Required Qualifications
- Bachelor or higher from an accredited institution
- 5+ years in healthcare industry (outpatient medical coding and billing operations, outpatient prior authorization or denials management, outpatient claims and processing optimization, payor claims design and edit management, and outpatient healthcare services research and analytics)
- Strong expertise in HCPCS/CPT, ICD-10-CM, and standard claims processing with proficiency in ICD-10-PCS, APC, and DRG classification and reimbursement methodologies
- Experience with Excel and databases; ability to learn computer applications for analysis
- Ability to work independently and in a team; high integrity and work ethic
- Familiarity with use of AI for research, analytics and automation of processes
- Relocation: not authorized
- Legal authorization to work in country of employment without sponsorship
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