BA Health Care Online Training|Support

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BA Health Care Course Content :

Business Analysis Basics

• Definition: Business Problem, Project Work and Operational
• BA Sphere of Influence – Developer, Tester, Quality Assurance, End-User, Business SME, PMO Personnel
• What a BA does? What a BA does NOT do?
• Requirement Gathering versus Elicitation Workshops
• Types of Requirements: Functional Requirement, Non-Functional Requirement, Security Requirements, Reporting Requirements, Notification Requirements, Transition Requirements

Business Analysis Deliverable Part 1: BRD & Process flows

• Requirements
• Data Flow Diagrams, As-Is Process Flow, To-Be Process flows
• Common Mistakes made by new business analysts, Wireframes, UI mock-ups.

Business Analysis Deliverable Part 2: Use cases

• Use Cases
• User Scenarios
• User Stories

Business Analysis Tools & Healthcare Tools

• HPQC- ALM
• Visual Use Case
• MS-VISIO
• Enterprise Architect
• FACETS Overview
• EMR System Overview

Industry Overview, Healthcare Reform, Healthcare Acronyms

• Healthcare in USA
• 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.

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

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

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 à Clinical Module versus Procedure Coding System
• Medical Loss Ratio
• Pharmacy Benefit Management

Provider Sector

• BPMN Basics – Pools, Lanes, Event, Activity, Gateway, Sequence, Group, Annotation!
• EMR/EHR
• EMR Implementation Projects
• Revenue Cycle Management Projects

JAD Session

• JAD Session, Verifying Requirements after a JAD Session
• One-on-One Meetings for Requirements: JAD Session Homework, Writing a JAD Session Agenda, JAD session inputs, Conducting a JAD Session, JAD Session Outputs, Recording draft requirements in Requirements management tool.

 

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