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.