Solventum HIS Clinical Analyst – Population Health Methodology Groupers

USA Solventum Health Information Systems, Inc.; Connecticut; Hybrid; USD 108,000 - 148,000; Full time

Benefits offered by this job

Medical, Dental & Vision

Health Savings Accounts

Disability benefits

Paid time off

Retirement benefits

Job summary

Solventum HIS Clinical Analyst role at Solventum requires a Bachelor degree and 5+ years in healthcare analytics, coding, payer operations, or related fields. You will design and validate methodologies using ICD-10-CM/PCS, HCPCS/CPT, DRG concepts, and reimbursement logic.

You will collaborate with product, research, and engineering teams to translate clinical concepts into executable specifications, maintain documentation, and support value-based care initiatives across payer and provider

Qualifications

• Bachelor or applicable certifications in a healthcare field and 5+ years in healthcare analytics or related areas.
• Experience with ICD-10 coding systems, billing workflows, and reimbursement methodologies.
• Ability to translate clinical concepts into executable specifications and documentation.

Responsibilities

• Design, develop and maintain proprietary healthcare methodologies (CRGs, PHEs, PPRH).
• Validate and test healthcare data to identify anomalies and improvements.
• Collaborate with Research, Product and Development to prioritize enhancements.
• Translate clinical concepts into documented logic using coding systems (ICD-10-CM, CPT, HCPCS).
• Maintain process documentation and update summaries per C&ER standards.

Skills

ICD-10-CM

ICD-10-PCS

HCPCS/CPT

DRG classification

Data analysis

Excel

Cross-functional collaboration

Education

Bachelor's degree

Tools

Excel

Databases

Analytical software

Job description

Job Description: Solventum HIS Clinical Analyst

Solventum is a new healthcare company with a long legacy of solving big challenges that improve lives and help healthcare professionals perform at their best. At Solventum, people are at the heart of every innovation we pursue. Guided by empathy, insight, and clinical intelligence, we collaborate with the best minds in healthcare to address our customers’ toughest challenges. While we continue updating the Solventum Careers Page and applicant materials, some documents may still reflect legacy branding. Please note that all listed roles are Solventum positions, and our Privacy Policy: https://www.solventum.com/en-us/home/legal/website-privacy-statement/applicant-privacy/ applies to any personal information you submit. As it was with 3M, at Solventum all qualified applicants will receive consideration for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

The Impact You Will Make in this Role

Solventum HIS is an international leader in designing and maintaining healthcare payment and quality outcome systems and advancing value-based care. We work closely with Medicare, Medicaid and commercial insurers on hospital, outpatient and population payment models and design quality outcome programs that promote patient safety and reduce avoidable costs. We also support more than ten countries on how they budget and pay for inpatient and outpatient care, and measure healthcare quality.

In this role, you will make an impact by: Serve as a hands-on clinical analyst, responsible for the design, development and maintenance of several proprietary Solventum methodologies to include Clinical Risk Groups (CRGs) and Patient Focused Episodes population health focused methodologies and Potentially Preventable Returns to Hospital (PPRH). These methodologies utilize healthcare data including diagnostic and procedural codes for determining payment and quality in healthcare.

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 efforts related to the methodologies, provide input into the prioritization of the potential research for enhancements.

Work directly with the Chief Product Owner, Product Owners, and Development team to drive enhancements to the methodologies by translating the clinical concepts into clearly documented, executable logic content specifications using existing coding systems (i.e., ICD-10-CM, CPT, and HCPCS) and knowledge of healthcare revenue cycle and outpatient coding and billing.

Collaborate cross-functionally while maintaining accountability with the technical, quality, and clinical team members, integrating product concepts to develop software components for each methodology.

Be responsible for maintaining process documentation for the methodologies, producing update summaries and other descriptive documents using C&ER standards and methods.

Your Skills and Expertise

To set you up for success in this role from day one, Solventum requires (at a minimum) the following qualifications: Bachelor or applicable certifications (completed and verified prior to start) from an accredited institution AND 5+ years' experience in the healthcare industry in one or more of the following: 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. AND In addition to the above requirements, the following are also required: 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 the application of AI technologies for research, analytics, and process automation. Ability to communicate technical and clinical information to a variety of audiences, including concepts related to coding systems and patient classification methodologies. Experience managing multiple priorities and subject areas within 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.

Additional qualifications that could help you succeed even further in this role include: Master's degree in health field, clinical informatics, clinical coding, and/or HIM credentials. Enthusiastic collaborator that energizes and leads others. High integrity and work ethic are expected and highly valued. Ability to take individual initiative and responsibility for assignments while working independently and in a team environment. 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. Demonstrated ability to effectively manage frequent context switching across multiple priorities and subject areas within a dynamic work environment. An ability to effectively communicate ideas, concepts, and information: presenting and training clinical concepts, coding systems and underlying design of patient classification methodologies in healthcare. The ability to collaborate with a diverse professional team including researchers, healthcare providers, and engineers. Familiarity with patient classification research and development: 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, bringing products from initial concept to release. Healthcare payer, delivery or industry experience in healthcare quality, population health, care management.

Supporting Your Well-being

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.

Onboarding Requirement

To improve the onboarding experience, you will have an opportunity to meet with your manager and other new employees as part of the Solventum new employee orientation. As a result, new employees hired for this position will be required to travel to a designated company location for on‑site onboarding during their initial days of employment. Travel arrangements and related expenses will be coordinated and paid for by the company in accordance with its travel policy. Applies to new hires with a start date of October1st2025 or later.

Applicable to US Applicants Only

The expected compensation range for this position is $107,600-$147,950, which includes base pay plus variable incentive pay, if eligible. This 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. In addition, this position may be eligible for a range of benefits (e.g., 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.). Additional information is available at: https://www.solventum.com/en-us/home/our-company/careers/#Total-Rewards

Solventum is an equal opportunity employer.

About Solventum

A new healthcare company with a rich history. With more than 70 years of delivering healthcare innovations, we continue to move the industry forward by helping to solve our customers’ biggest challenges. 20,000+ employees worldwide. Solventum relies on the courage and a boundless insights of professionals worldwide to achieve exceptional results for our customers and those who rely on them. Healthcare that leads with heart and humility starts with listening and never finishes, only evolves. As long as healthcare challenges remain unsolved, we will be here, united by empathy and a relentless belief that countless lives are improved through our work. Operations in 38 countries. Driven by our dedication to improved outcomes for all we serve, we break through by making unprecedented connections that impact lives. In more than 300 offices and facilities around the world, we work closely with customers and partners to create positive healthcare outcomes that transcend borders. To realize our shared vision, we harness diverse talents and perspectives from every background to not only address our customers' most urgent priorities but anticipate the needs of the future.