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.

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