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Health Care Domain

You are here: Home1 / EBooks2 / Health Care Domain
16-20

Hours

24/7

Course Access

3 Months

Course Access

Core Health Care Domain Training Covering Commercial and Government Health Care Plans, HIPAA, Health Care Management Systems, ICD9 to ICD10 conversion, Coordination of Benefits and Third Party Liability.

Comprehensive, All-inclusive Course

Delivered by Practicing Health Care Professional

Try a FREE Demo! Get Instant Access!!
Unlock the Full Program (20% off using code MYDOMAIN) 2 Months Access

Program Overview

How Specializing as a Domain Expert can Amplify your BA Profile

Set Yourself Apart from Your Competition

Quality for positions that require Finance knowledge and expertise. Increase the number of positions you are eligible to apply to multiple fold. You will not only become a preferred candidate for positions that require a generic BA, but also able to apply exclusively to Finance positions that your competition don't stand a chance!

Demand the Rates you Deserve

Domain Experts typically have a much higher billing rate compared to generic BA counterparts. You can achieve 100K+ rates much sooner when you have command over a domain area!

Stay on Contracts Longer

Domain Experts enjoy a higher retention rate. When the market is flooded with resources, BA resources with a better understanding of domain terminology and business processes have a much higher chance of retention on complex projects, while generic BAs become easily replaceable resources.

Attend a Free Healthcare Domain Career Info Session

In the Free Info Session, you will Learn..

  • Benefits of becoming a Domain Expert
  • Health Care Domain Terminology
  • Overview of topics covered in the full program
  • How we can help you achieve your goal of becoming a Domain Expert

Free Info Session Slides:

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This course is designed to be taken independently from the BA Workshop Course.

Product Description

Explore Health Care Business Analysis.. Our Course Highlights..

  • Health Care Terminology
  • Commercial Health Care Plans: Preferred provider organization (PPO), Exclusive provider organization (EPO), Health maintenance organization (HMO), Supplemental Insurance, MediGap
  • Income Government Health Care Plans: Medicaid and Medicare – Eligibility and Coverage
  • Health Insurance Portability and Accountability Act (HIPAA): Basics, HIPAA Transactions [837 - Claims submission, 834 - Enrollment, 820 – Premium Payments, 270/271 – Eligibility and Benefits, 278 – Authorization], 4010 to 5010 conversion
  • ICD 9 to ICD 10 Conversion: What are ICD Codes? Benefits of Conversion, Analysis Guidelines, Testing Considerations
  • Coordination of Benefits (COB)
  • Third Party Liability (TPL)
BONUS Topics:
  • Section 111 Reporting
  • Health level 7 (HL7)

Detailed Course Content

Health Care Terminology

  • Subscriber
  • Member
  • Provider
  • Claims
  • Coinsurance
  • Copayment
  • Deductible
  • FSA (Flexible spending accounts or arrangements)
  • MSA (Medical Savings Account) / HSA (Health Spending Account)
  • In-depth Terminology
    • Coverage Type
    • Enrollment, Effective and Termination Dates
    • Capitation
    • etc.
  • PHI
  • HIPAA
  • Health Care Plans
  • COB
  • TPL
  • ICD Codes – ICD9 vs. ICD10
  • HL7

Commercial Health Care Plans

  • Preferred provider organization (PPO)
  • Exclusive provider organization (EPO)
  • Health maintenance organization (HMO)
  • Supplemental Insurance
  • MediGap

Government Health Care Plans

  • Medicaid
    • Eligibility
    • Coverage
  • Medicare
    • Eligibility
    • Coverage

Health Insurance Portability and Accountability Act (HIPAA)

  • What is HIPAA?
  • HIPAA Basics
  • HIPAA Transactions
  • 837 - Claims submission (Professional / Institutional and Dental)
  • 834 - Enrollment (Benefit Enrollment and Maintenance)
  • 820 – Premium Payments (Payroll Deducted and Other Group Payments)
  • 270/271 – Eligibility and Benefits (Health Care Eligibility Inquiry and Response)
  • 278 – Authorization (Health Care Services Request for Review and Response)
  • 4010 to 5010 conversion

Health Care Systems

  • Member Management
  • Provider Management
  • Reimbursement Management (Claims Processing)
  • Benefits Administration
  • Prior Authorization
  • Rate Setting

ICD 9 to ICD 10 Conversion

  • What are ICD Codes?
  • Benefits of Conversion?
  • Concerns
  • Things to account for
  • Analysis Guidelines
  • Testing Considerations

COB and TPL

  • Coordination of Benefits (COB)
    • What is COB?
    • Why COB?
    • COB Rules
  • Third Party Liability (TPL)
    • What is TPL?
    • Why TPL?
    • TPL Rules

Bonus Topics

  • Section 111 Reporting
  • Health level 7 (HL7)
Download Course Package
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