BA HEALTH CARE

BUSINESS ANALYST HEALTH CARE
About the Course: Healthcare management professionals work as administrators, managers, CEOs, planners and more. Through the efforts of well-trained and caring healthcare managers, patients are treated to state-of-the-art facilities, compassionate medical treatment, and an overall positive healthcare experience. Individuals who choose to pursue this career path tend to be sympathetic, caring personality types with an honest desire to help others.

With the proliferation of online degrees, a degree in health care management is more attainable than ever. Individuals who would once have been held back from advancing in their professional careers due to other obligations, such as work schedules or childcare, can finally obtain the vital training they need to pursue the career of their dreams. A career in healthcare management offers financial stability, a booming job market, and the emotional satisfaction of working in an industry that provides a vital service to the community.

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


Last modified: Sunday, 17 July 2016, 11:49 PM