BA/QA Domain Specialization
Healthcare BA QA
Duration: 25 hours / 1 month course
The health care industry is possibly the fastest growing domain in the United States. Yes-M Systems providing Healthcare Domain Training with real time projects. 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.
Key Features
1. Introduction to US health care system
- Domain pillars
- Regulations, compliance and mandates
- HIPAA Law
- Terms and terminology
- Administrative and Clinical Functional division
- Managed Health concept
2. Product Design
- 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
3. Introduction to administrative transactions
- 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
4. X12 concepts deep-dive
- 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
5. Clearing House
- Clearing houses as independent TPA
- M-1 and M-M (B2B) models
- Use Cases and companion guide integration
6. Codes
- Local and global code sets
- Diagnosis, procedure, health care status, remark, NDC, taxonomy LOINC codes
- ICD 9 – ICD 10 conversions
- General equivalence mapping
7. Claims Processing
- 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
8. Medicare and Medicaid
- Overview of the programs
- Qualification criteria
- Medicare advantage and Medicare supplementary
- Medicare cross-over claims
- Coordination off benefits
- State Medicaid programs , MITA architecture
9. Pharmacy
- Rx benefits
- Pharmacy Benefit managers
- Formulary and manufacturers
- E-prescription and integration with EMR systems
- NCPDP claims , encounter reporting
10. Clinical Data Management
- 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
11. Preventive Care
- Utilization Management
- Case and Disease management
- Care Management and alerts
12. A look at new technology usage in healthcare
- Cloud service usage
- Big Data
- AI and Machine Learning
- Blockchain
Assignments rolling into Projects
- Clearing House integration with Payer for 837p and 276 transactions includes X12, data mapping, companion and implementation guides
- PAPI to NPI conversion using LUHN algorithm
- Member website use case modeling
- Enterprise imaging systems conversion of paper claims to electronic forms
- Microsoft health vault integration with third party wellness services
- Open EMR reverse engineering
- Includes XML, SQL, WSDL, Data Mapping, use case, UML, supp specs, JAR, wire-frames
End of the course activities
- Question bank from interviews walk through
- Interview questions, demo of answers and open discussion
- Mock interview sessions
- Resume preparation and critic
- One on one individual sessions with all class students
BA/QA Domain Specialization Testimonials
Yes-M Systems is the best online training company I have come across. After through research luckily I chose Yes-M Systems to get training for BA and Healthcare classes. After training I was very much confidant and got job within 3 months of completion of training. Yes-M Systems is a very professional company. I would highly recommend YesM Systems to anyone seeking IT training in any field.
Paul K
I did BA/QA Domain Specialization Healthcare course with Yes-M Systems in august 2016. It was great learning experience, all the instructors are very professional and knowledgable. The assignments that they give will helps in understanding the topics well. Yes-M Systems has good HR team which help in resume preparation and mock interviews. I would definately recommend my friends who are interested for BA course.
Diggavi
I am totally satisfied with BA/QA Domain training, Yes-M Systems training was thorough, intense, fast-paced, project based. All instructors were very knowledgeable, Nandu really helpful, always responded promptly , always available for guidance. In few weeks you can get to learn a lot, from basic to advanced topics – use case to user story, from waterfall approch to agile methodology, I loved the JAD class and UML class. Vanketash is very knowledgeable instructor, never was frustrated of any question. Not to forget every week I see at least one BA/QA opening offered from Yes-M Systems.
Jaxon
I did my BA Domain Specialization course with Yes-M Systems and the training absolutely was an amazing experience. Nandu explained the topics really well which helped me understand the role and responsibility of a BA in real world, be it requirements gathering, MS Visio or UML, use cases or all the methodologies. I give Yes-M Systems a thumbs up and definitely the right place for anyone looking forward to become a BA. Not to forget the resume preparation and mock up interviews that the team imparted was commendable… Must say, really helped me because I joined Yes-M Systems!
Saraju
Disclaimer: Yes-M Systems and/or their instructors reserve the right to make any changes to the syllabus as deemed necessary to best fulfill the course objectives. Students registered for this course will be made aware of any changes in a timely fashion using reasonable means.
