Healthcare Business Analyst Course
Unit 1: Business Analyst Course Basics
- Introduction to Business Analysis
- Importance of Effective Business Analysis
- Business Composition and Architecture
- Roles and Responsibilities of a Business Analyst
- Need for a Business Analyst
- Standardization and Adaptability
- Importance of Communication/Collaboration
- Project Team
- Importance of Business Analyst in the Project Team
- Business Analyst Career Path
Unit 2: Business Analysis Deliverables Part 1: BRD & Process flows
Unit 3: Business Analysis Deliverables Part 2: Use cases
Unit 4: BA Tools & Healthcare Tools
Unit 5: Industry Overview, Healthcare Reform, Healthcare Acronyms
- Healthcare in USA and Canada
- What are the major sectors of the industry, where are the jobs , MCD, MCR, MMIS
- What is healthcare reform – basics
- Health Insurance Concepts: Premium, Deductible, Co-pay, Co-insurance, Exclusions, MLR, OOPMax, EHBs, Capitation versus FFS, In-network, OON, Prior-Auth, Pre-cert, EOB, AV-Values, etc.
- What are the common short-forms in healthcare interview, what each one means, when to not use which short-forms.
Unit 6: Types of Insurance & Healthcare Insurance Exchange (HIX)
- The biggest provision of the healthcare law is HIX, THIS is where the jobs are
- What is an Exchange, how does it work, who do exchange people work with
- What is a state-run HIX, what is a Federal HIX
- What are the different functions of the exchange – eligibility, enrollment, plan management, risk, re-insurance & risk corridors
Unit 7: EDI & Claims
- What are EDI transactions, different types, ANSI, ASCX12, EDIX12, Meanings, Uses and Formats of the following: HIPAA EDI 837, 834, 835, 820, 270, 271, 277, 278
- What are EDI implementation guides, what are EDI Companion guides? How to read them? How to write EDI requirements? What business rules do EDI transactions follow?
- What is an EDI transaction? What are the parts – loops, segments, delimiters, etc?
- What is claims lifecycle? Who pays for claims & how is payment transmitted? What is Revenue Cycle Management
Unit 8: Healthcare Small Topics
- What is ICD? Why ICD-10? What are CPT Codes, What are HCPCS codes? What is HCFA-1500? What is UB04 Form?
- What are NCQA standards?
- What is MMIS of CMS? What do they do?
- Conversion means what? What is data mapping? What is ICD-9 to ICD-10 crosswalk? What are the online conversion tools?
- ICD-CM versus ICD-PCS ◊ Clinical Unit versus Procedure Coding System
- Medical Loss Ratio
- Pharmacy Benefit Management
Unit 9: Provider Sector
Unit 10: JAD Session