About Nayya
At Nayya, we believe there’s a better way to choose benefits. A more transparent, less confusing way for employees to control their health and financial potential. Powered by billions of data points and machine learning, our benefits experience platform delivers personalized decision support and guidance during open enrollment, new employee onboarding, qualifying life events, and in the moments that matter all year round. This is one of the most stressful and challenging situations consumers face – and we see that as an opportunity to build an innovative response that can help millions of Americans possess the control and understanding they deserve.
About the Role:
Nayya is looking for a driven and experienced contractor with a strong background in medical claims coding and billing. This individual will internally validate Nayya’s medical event identification approach using claims data. The individual will provide an independent assessment of Nayya’s overall framework of medical claims identification inclusive of risks and recommendations. This resource’s role will primarily be to bring expertise and credibility in translating claims data into technical benefit features that can be replicated across multiple carriers and employers.
Time Requirement:
This is a 4-week contract position, 15-20 hours a week with the potential to be extended further.
Responsibilities:
- Review supplemental health plan carrier certificates and benefit designs, outline best practices, create alignment, and make recommendations in the identification of medical events for supplemental health benefits
- Review the analytics medical event identification framework and make recommendations on enhancements and risks of the current process
- Use expertise to clinically designate appropriate medical codes including diagnosis and procedure codes to supplemental health benefits
- Provide formal and informal education to members of the analytic teams regarding coding and billing decisions on claim form submissions and documentation
Qualifications and Requirements:
- 5+ years of healthcare experience in a medical coding and billing setting
- In-depth working knowledge of standard diagnosis and procedure codes, including but not limited to ICD-10 (including ICD-10-CM and ICD-10-PCS), HCPCS, CPT, NDC
- Familiarity with Episode groupers is highly preferred.
- Experience consulting rules engines for health technology organizations is highly preferred
- Familiarity with supplemental health plans, such as Critical Illness (CI), Hospital Indemnity (HI) and Accident
- Registered Health Information Administrator (RHIA), Certified Billing and Coding Specialist (CBCS), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC) certification, or Certified Coding Specialist (CCS) required
Key Deliverables:
- An written evaluation of Nayya’s medical event identification approach which includes a summary of:
- Recommendations for enhancements in the framework
- Risks in the approach
- Identified gaps between supplemental health benefit descriptions and medical claims data information
- A recommendation on key codes and fields for 10 medical events that map to supplemental health benefits (to independently validate Nayya’s approach)
- A recommendation on key codes and fields that map to 4 medical exclusions for benefits (to independently validate Nayya’s approach)
- Informal consultation to analytics team members on ongoing claims data question when required.
- A high level walkthrough of the claims billing and coding life cycle with documented materials to present to the analytics team
The salary range for New York based candidates for this role is $80/hour - $100/hour. We use a location factor to adjust this range for candidates that are located outside of geographic region of our New York office. Placement within the salary band is determined based on experience.#LI-KA1
Why Join Nayya?
- Be an early employee of a quickly growing, VC-backed start-up - grow with us!
- Have a meaningful impact on a platform that is scaling very rapidly
- Contribute to a values-based culture with an emphasis on empowerment and autonomy
- Work in a highly collaborative, cross-functional environment
- Benefits include: Competitive pay, employer-paid healthcare, stock options
Nayya is proud to be an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics
