BA Health Care Training

BA Health Care Training

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

  • Visual Use Case
  • 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 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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