BA HEALTH CARE

BA HEALTH CARE

Overview:
Health Care Management program learn to plan and deliver health care programs, implement policies, guide the activities of personnel, and make effective business decisions for health care systems or organizations. Our real time trainers explain the medical industry, implement policies. Decisions for health care systems, organization

Training Objectives of BA HEALTH CARE:
• Learn Insurance Life Cycle and Healthcare Insurance products
• Understand project scope and project plan in a real business scenario

Target Students / Prerequisites:
Basic knowledge on Healthcare processes and concepts

COURSE CONTENT:

Business Analysis Basics
Definition: Business Problem, Project Work and Operational;
Introduction to project Team;
Dos & don’ts of BA?
Requirement Gathering versus Elicitation
Types of Requirements: with– EXAMPLES
Business Analysis Deliverable: BRD & Business Process flows
Requirements (using waterfall and Agile model)
Data Flow Diagrams
Current Process Flow, Future Process flows
Business Analysis Deliverable Part 2: Use cases
Use Cases
User Scenarios
User Stories
Healthcare Introduction
Overview
Medicare vs. Medicaid
Payer vs. Provider
Business Analysis Tools & Healthcare Tools
HPQC- ALM
Visual Use Case or similar tools
MS-VISIO
FACETS Overview
EMR & EHR System Overview
Lab Book & LIMS
Healthcare mandates and Acronyms
Healthcare in USA
Healthcare reform and other mandates
Jobs in the healthcare industry MCD, MCR, MMIS, HIX
Health Insurance Concepts: Premium, Deductible, Co-pay, Co-insurance, Exclusions, OOPMAX EHBs, Capitation versus FFS, In-network, OON, Prior-Auth, Pre-cert, EOB, EOP etc.
Common terms in healthcare interview.
Types of Insurance & Healthcare Insurance Exchange (HIX)
HIX and HUB Overview
State-run HIX vs. Federal HIX
Functions of the exchange – eligibility, enrollment, benefit- plan management, risk, re-insurance & risk
EDI & Claims
What are EDI transactions, different types, ANSI, ASCX12, EDIX12
HIPAA EDI 837, 834, 835, 820, 270, 271, 277, 278
EDI implementation guides vs. Companion guides
EDI transaction parts – loops, segments, delimiters
Claims lifecycle from billing to payment
Revenue Cycle Management
ICD Overview
CPT Coding
Modifiers
Unlisted Codes
HCPC National Level II Codes
CPT Coding with Manual
ICD History
Why ICD codes?
ICD Codes – What does it tell us?
Use of ICD codes
Anatomy and Terminology for Coders
Advanced Anatomy and Terminology for Coders
Coding for the Non-Coder Preparation Analyzer
Anatomy and Terminology Essentials from an ICD-10-CM Perspective
Anatomy and Terminology Essentials from an ICD-10-PCS Perspective
General Equivalence Mappings (GEMs)
ICD 10 Implementation phases
ICD-10 Release Timeliness
ICD-10 Impact to Payer
Provider Sector
EMR/EHR
EMR Implementation Projects
LIMS/Lab book projects
Revenue Cycle Management Projects
JAD Session
JAD Session –hand on experience
Resume Preparation
Resume Review
Resume Preparation Tips
Sample Resumes
Interview Preparation:
Mock Interviews
Interview Preparation Tips
Sample Interview Questions
How to clear an Interview