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BA Health Care Domain ONLINE TRAINING

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Course type: Online Instructor led Course

Course ID: 15976

Course type: Online Instructor led Course

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About SrinivasGlory

We stay with you until you get the results you want. If you really interested, please let me know . We will arrange the Demo Session, Feel Free to call us any time

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Srinivas
Glory IT Technologies
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About the Course

Glory IT Technologies provides BA Health care Online Training.Whether you are just starting out or know something about Business Analyst Healthcare, get the core knowledge of Healthcare Business Analyst you need to get up to speed, and get the most out of our online Business Analyst Healthcare domain training. Get the best-in-class Healthcare Business Analyst online training by our healthcare business analyst specialist.

Topics Covered

Business Analyst Health Care Domain

? Healthcare Market Overview
? Introduction
? Current healthcare market trend in US
? What is an HMO
? The Industry Outlook
? Trends in Healthcare – Provider Space
? Trends in Healthcare – Payer Space
? Key Players
? References
? Healthcare Overview
? Unit Objectives
? Genesis Of Healthcare
? How the industry Works?
? Healthcare pillars
? Members
? Providers
? Benefits
? Claims
? Sales
? External Agents
? Healthcare workflow
? Summary
? Review Questions
? References
? Members
? Unit Objective
? Introduction
? Insurance Business: An Overview
? Individual and Group Insurance in detail
? Individual Insurance
? How to get individual insurance?
? Group Insurance
? Company Paid Groups
? Affinity Groups
? Self Insured Group
? Self-Employed Members
? Exercise
? Member’s enrolment
? What is Enrollment?
? How is enrollment carried out?
? Output of enrollment process
? Enrollment: Overall Picture
? Exercise
? Member’s and Dependent’s eligibility
? Eligibility
? Eligibility Process
? How a member should approach right provider?
? Eligibility Data Transfer
? Eligible Dependents
? Exercise
? Member Services
? Means of services
? Services provided by the insurer
? Premium Collection
? Member Group Maintenance
? What are Groups?
? Groups Formation
? Groups Maintenance
? Disability Benefits
? Member’s concern
? Exercise
? Provider
? Provider types
? Provider Participation
? Provider Contract
? Provider Contract Process
? Credentialing Criteria
? Verification of Provider Credentialing Information
? Types of Contracts
? Provider Reimbursement
? Exercise
? Provider Referral
? Referrals processing
? Referral types
? Provider Network
? Quality Provider Networks
? Network Adequacy
? Rental networks
? Network Hospital Standards
? Provider maintenance
? some common information of Providers
? Exercise
? Review Questions
? References
? Sales
? Unit Objectives
? Introduction
? Brokers
? Calculation for Brokers
? Quote Creation
? What is a quote?
? The Process Of Quote Creation
? Actuaries
? Underwriters
? Insurance Payer’s Sales Department
? External Agents that deal with Sales Department of Insurance Payers
? Review Questions
? Benefits
? Unit Objectives
? Introduction
? Indemnity Plans
? Managed Care Plans
? Health Maintenance Organization (HMO)
? Preferred Provider Organization (PPO)
? Point Of Service (POS)
? Exclusive Provider Organization (EPO)
? Which plan is the best?
? Exercise
? Other Plans
? Vision Plans
? Dental Plans
? Pharmacy Plans
? Medicare Plans
? Medigap
? Medicaid
? Long Term Care
? Disability Income Insurance
? Catastrophic Coverage Plans
? Exercise
? Individual Insurance and Group Insurance
? Laws and Legislations
? Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA)
? Health Insurance Portability and Accountability Act (HIPAA)
? Review Questions
? References
? Claims
? Claim generation and submission to Providers
? Claims Intake Process
? Claims Intake : Diagrammatic
? Claim Adjudication Process
? Claim Preparation and determining eligibility
? Determine payment
? Update Claim
? Claim adjudication outputs
? Claim Payments
? Provider Payments
? Member Re-imbursement
? Member Re-imbursement
? Refund Adjustment
? Minus Debit Adjustment
? Minus Debit Adjustment
? Minus Debit Adjustment
? Stop Adjustment
? Government reporting
? Explanation of Benefits (EOB)
? Accumulators
? What are Accumulators?
? Function/Purpose of Accumulators
? What is accumulated?
? Types of Accumulator
? Overall Claims system diagram
? Review Questions
? References
? External Agents
? Unit Objectives
? Introduction
? Government Agencies
? Centers for Medicare & Medicaid Services (CMS)
? DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHSS)
? Centers for Disease Control and Prevention (CDC)
? Agency for Health Care Research and Quality (AHRQ)
? National Information Center on Health Services Research and Health Care Technology (NICHSR)
? Health Resources and Services Administration (HRSA)
? Exercise
? Government Acts and Regulations
? HIPAA
? ELECTRONIC HEALTH TRANSACTIONS STANDARDS
? CORBA
? Exercise
? Clearing Houses
? Benefits Of A Clearinghouse
? Clearinghouse versus Direct Filing
? Clearinghouse Income
? Exercise
? Third Party Administrators
? Specialized Adjudication Engines/Companies
? General Agents
? Accreditation Agencies
? The Accreditation Process
? Drug Manufacturers
? Review Questions
? References
? Summary
? Unit Objectives
? Workflow
? The Beginning: Member wants to purchase insurance
? Getting a provider
? An Enrolled member wants to seek medical services.
? Member has filed a claim
? Effect of external agencies
? Review Questions
? References.
? Appendices
? Total E-Business Services Forecast for Healthcare
? The world Healthcare market and Healthcare IT spending
? The Cash Flux of the US Healthcare Industry
? Sample Quote Sheet

Who should attend

every one should attend for online training no discrimination

Pre-requisites

Pre-Requisites:

Entry-level IT Business Analysts
Non IT professionals aspiring to get into Business analysis/analyst.
Self-taught IT Business Analysts wanting to fill in the gaps and put all the pieces together
Systems Analysts and programmers interested in expanding their role into the business area

What you need to bring

no need to bring any one with your own pace you will learn online training"

Key Takeaways

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Discussions (1)

Pls provide contact details

By Praveen

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Students Interested 6 (Seats Left 0)

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