Introduction

Business Analysis with Healthcare domain knowledge combines with Business Analyst skills to give a customized skillset for an individual looking to make a career as a Business Analyst in the Healthcare domain. This explores many business processes, use cases at every point of contact where the patients interfaces with the healthcare professionals. A Business Analyst should equipped with clinical trial knowledge and with various tools usage like SAS, HPQC- ALM, MS Visio, etc.

Course Objective

After the completion of this course, Trainee will:
1. Determine the primary role of a Business Analyst in a business
2. Understand project scope and project plan in a real business scenario
3. Learn Insurance Life Cycle and Healthcare Insurance products
4. Master in determining and analyzing business requirements document and business requirement Tools
5. Create a test plan as per the requirements using various testing methodologies
6. Learn different software development methodologies (waterfall, Agile, Spiral, RAD, Scrum)
7. Gain Knowledge on Prototyping and JAD [Joint Application Development], types of requirements (Business, Functional, Non-Functional, Transition, UI etc).

Pre-requisites

1. Candidates should have education or background in some aspect of the life sciences, healthcare, IT, pharmaceutical, medical devices, or related areas
   2. Basic knowledge on Healthcare processes and concepts

Course Curriculum

Unit 1: BA Basics

• 1. Introduction to Business Analysis
• 2. Importance of Effective Business Analysis
• 3. Business Composition and Architecture
• 4. Roles and Responsibilities of a Business Analyst
• 5. Need for a Business Analyst
• 6. Standardization and Adaptability
• 7. Importance of Communication/Collaboration
• 8. Project Team
• 9. Importance of Business Analyst in the Project Team
• 10. Business Analyst Career Path

Unit 2: Business Analysis Deliverables Part 1: BRD & Process flows

• 1. Requirements
• 2. Data Flow Diagrams, As-Is Process Flow, To-Be Process flows, Common Mistakes made by new Business Analyst, Wireframes, UI mock-ups

Unit 3: Business Analysis Deliverables Part 2: Use cases

• 1. Use Cases
• 2. User Scenarios and
• 3. User Stories

Unit 4: BA Tools & Healthcare Tools

• 1. HPQC – ALM
• 2. Visual Use Case
• 3. MS-VISIO
• 4. Enterprise Architect
• 5. FACETS Overview
• 6. EMR System Overview

Unit 5: Industry Overview, Healthcare Reform, Healthcare Acronyms

• 1. Healthcare in USA
• 2. What are the major sectors of the industry, where are the jobs , MCD, MCR, MMIS
• 3. What is healthcare reform – basics
• 4. 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.
• 5. 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)

• 1. The biggest provision of the healthcare law is HIX, THIS is where the jobs are
• 2. What is an Exchange, how does it work, who do exchange people work with
• 3. What is a state-run HIX, what is a Federal HIX
• 4. What are the different functions of the exchange – eligibility, enrollment, plan management, risk, re-insurance & risk corridors

Unit 7: EDI & Claims

• 1. 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
• 2. 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?
• 3. What is an EDI transaction? What are the parts – loops, segments, delimiters, etc?
• 4. What is claims lifecycle? Who pays for claims & how is payment transmitted? What is Revenue Cycle Management

Unit 8: Healthcare Small Topics

• 1. What is ICD? Why ICD-10? What are CPT Codes, What are HCPCS codes? What is HCFA-1500? What is UB04 Form?
• 2. What are NCQA standards?
• 3. What is MMIS of CMS? What do they do?
• 4. Conversion means what? What is data mapping? What is ICD-9 to ICD-10 crosswalk? What are the online conversion tools?
• 5. ICD-CM versus ICD-PCS à Clinical Unit versus Procedure Coding System
• 6. Medical Loss Ratio
• 7. Pharmacy Benefit Management

Unit 9: Provider Sector

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

Unit 10: JAD Session

• 1. 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.