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The health care industry is possibly the fastest growing domain in the United States. In the past 15 years major government mandates and regulations like HIPAA, NPI, ICD, HITECH and ACA have infused substantial investments across all major organization types. Competitive advantage of the payers in terms of medical loss ratio is a continuous challenge. Data science, machine learning and preventive care is performing a stellar role in realizing those goals. This course is tailor-made for the next generation business/ quality analyst who is ready to plunge into this gripping arena, supplement their skill-set with concrete knowledge through a riveting but compact series of classes, assignments and project work. Business Analysts are responsible for identifying business needs, requirements development and requirements management. Business Analyst is the practice of enabling change in an organizational context, by defining needs and recommending solutions that deliver value to stakeholders. Business analytics is used by companies committed to data-driven decision-making.

Module List

  • BA Basics
  • BRD and Process Flows
  • Use Cases
  • BA Tools and Health Care Tools
  • Industry Overview , Healthcare Reform ,Healthcare Acronyms
  • Types of insurance and healthcare insurance Exchange (HIX)
  • EDI and Claims
  • Healthcare Small Topics
  • Provider Sector
  • JAD Session

BA HEALTH CARE Course Details

    • Domain pillars
    • Regulations, compliance and mandates
    • HIPAA Law
    • Terms and terminology
    • Administrative and Clinical Functional division
    • Managed Health concept

    • Basic concepts and flow diagram
    • Service types and benefit types
    • Schedule of benefits, fulfillment
    • Dive into analytics
    • Benefit package and products
    • Line of business
    • Group and individual market
    • QHP and MLR
    • Public and Private Exchanges

    • A look into basic HIPAA X12 transactions
    • 270-271 , 837i/p/d , 276-277, 278-13, 278-11, 835, 834, 820, 275
    • CMS-1500 and UB04 forms
    • Crosswalks and gateway systems

    • Building blocks of a X12 transaction
    • Business analysis life-cycle between trading partner interactions
    • Segments, elements and rule-sets
    • Data mapping using the implementation guide (TR3 reports)
    • Companion guides
    • VCML and transport mechanisms

    • clearing houses as independent TPA
    • M-1 and M-M (B2B) models
    • Use Cases and companion guide integration

    • Local and global code sets
    • Diagnosis, procedure, health care status, remark, NDC, taxonomy LOINC codes
    • ICD 9 – ICD 10 conversions
    • General equivalence mapping

    • E2E Payer system layouts
    • Claims processing and adjudication steps including claim check rules
    • Finance and revenue management
    • Warehousing and audit process
    • Fee schedule based vs. Capitation
    • Facets documentation

    • Overview of the programs
    • Qualification criteria
    • Medicare advantage and Medicare supplementary
    • Medicare cross-over claims
    • Coordination off benefits
    • State Medicaid programs , MITA architecture

    • Rx benefits
    • Pharmacy Benefit managers
    • Formulary and manufacturers
    • E-prescription and integration with EMR systems
    • NCPDP claims , encounter reporting

    • Electronic health records
    • Individual, payer based and provider based records
    • ADTs and ORU transactions
    • CCDA transactions
    • Microsoft HealthVault platform and integration
    • EMR systems and use cases
    • HITECH bill and certified EHR
    • National Health Information network

    • Utilization Management
    • Case and Disease management
    • Care Management and alerts

    • Cloud service usage
    • Big Data
    • AI and Machine Learning
    • Blockchain

Training Advantages
35 contact hours
Industry Case Studies
Industry case studies
Real time training


    Yes. Course counseling would pave a way for the trainers to understand your needs and the trainees to understand the trainer’s offerings. It is smart enough to avail free course counseling before enrolling for the course.

    Being one of the leading careers in the job market, Business Analysis professions have greater significance and career growth. But in order to break the hurdles involved in securing a Business Analyst job, the professional training course would be the ideal way. Many recruiters prefer candidates who are professionally trained over those who aren’t trained.

    An important advantage of choosing the above professional training courses is the comprehensive placement assistance associated with the course. Every training provider would have a dedicated placement cell to assist the trainees to land effectively in a Business Analyst job.

    Averagely, Business Analysts are among the high paid professionals around the world And every job portal and professional platforms show the flooding opportunities for business analysis skills.

    According to pay scale, an average salary paid to the Business Analyst professional in and around the United States of America is $66,913

    Yes, every training course you’re enrolled at this page would guarantee you a certification for training availed. Since every institute is authorized to provide training and education, certification after the training course would help you to convince the recruiters that you’ve gone through proper training.

    (Note: This certification is different from Expert certifications from the Cloud era, Horton works, MapR. In fact, no training provider can give you that expert certification just for availing the training course. Only after learning Hadoop technology and acquire expertise on the same would help you to get the certification. Anyone can register for those certification exams after acquiring expertise.)

    The different designations given to Business Analyst professional are Management Analyst, Financial Analyst, IS (Information Security) Analyst, Budget Analyst and CS (Computer Systems) Analyst.