Business Analysis with Healthcare Certification Training

Business Analysis with Healthcare domain bolster the efficiency and profit of medical facilities by evaluating their financial activity, data management and services. Process adaption and business transformation are critical for surviving successful business enterprises competitively. This training will teach trainees how Business Analyst communicates requirements from customers, managers and Subject Matter Experts (SMEs) to technical deployment teams to ensure the optimized solutions are designed and implemented to cater Healthcare field. Trainees will gain in-depth knowledge on the key concepts and terminologies in the Healthcare domain and the various healthcare plans provided by the US government.

About the course:


Business analysis is the art of requirements management with the potential support to the whole of the project life cycle. A potential business analyst candidate will have to the basic knowledge of requirement methodologies, testing methods, implementation cycle, software development process framework.

If any particular Business analysis certification like ISEB has been done, then the prospects of the candidate is good for the position of a business analyst. But if the business analyst position is for a particular domain such as healthcare, then there are lot more expectations from the business analyst candidate.

Healthcare domain is a more complex domain and requires a good working background in the industry to know in detail its business process and internal workings.

The healthcare domain requires an in depth knowledge of the workings of the hospitals and laboratories as there are many intrinsic differences in this industry. There are several political, socio-economic and legal issue to be taken care of while dealing with the business processes.

Techniques and technologies used in the healthcare domain have undergone a sea of change from the past few years and the business analyst candidate will have to have a good grasp of these processes and be technologically sound.

The business analyst’s job in the healthcare domain is not only to provide better processes and software packages but also to ensure that the time lines, cost and accuracy are adhered to as the systems are linked to actual human lives and any mistake, problem or slip up may result in disaster directly or indirectly.

Why learn and get certified in Business Analysis with Healthcare?

  1. MNC’s are looking to employ qualified professionals as Business Systems Analyst, Healthcare Business Analyst, and Business Analyst and so on and this certification will increase your visibility to such employers
    2. According to one of the renowned recruitment portal, the average salary of the Business Analyst in the Healthcare is more than the average salary of a software engineer. Thus the specialization of Business Analyst in Healthcare ensures higher pay due to the scarce availability of qualified professionals
    3. It allows for utilization of skills across the domains of IT, Business Management and Healthcare which increases employability of the individual post certification
    4. As per the US Bureau of Labor Statistics (BLS), it is expected that there will be 19% increase in the job over the 2012 – 2022 decade

Learning Pathway with I Smart Learning (Course Curriculum)

BA Basics:

  1. What is BA and Introduction to BA
  2. Importance BA in healthcare and Effective business analysis
  3. Roles and responsibilities of BA
  4. Need of BA to the industry
  5. Business composition and Architecture
  6. Importance of collaboration and composition
  7. Standardization and Adaptability of the Business
  8. Involvement of Project Team
  9. Importance of BA in the Project Team
  10. BA Career path

Business Analysis deliverables Part 1 : BRD AND Process flows

  1. Requirements
  2. As-Is Process flow
  3. To-Be Process flow
  4. Wire Frames, Data Flow Diagrams
  5. UI Mock ups
  6. Common mistakes made by BA.

BA deliverables Part 2 :  User Cases, Scenarios and stories.

BA and Healthcare Tools:

  1. Visual use case
  2. MS- VISIO
  3. Enterprise architect
  4. Overview of facts
  6. Over view of EMR system

Industry overview, Healthcare reform and Acronyms

  1. Healthcare in USA
  2. What are the major sectors and jobs of the Industry LIKE MCD, MCR, MMIS
  3. Definition of Healthcare reform and basics
  4. Health Insurance concepts : Deductible, Premium, Co- Insurance, Co-Pay, Exclusions. MLR, OOPMax, EHBs, Capitation versus FFS, In-Network, OON, Prior- Auth, Pre- Cert, EOB, AV-Values etc.
  5. Learning of common short forms of Health care interview, what each term means, when to use, when not to use and which short terms.

Types of Insurance and Healthcare Insurance Exchange (HIX)

  1. HIX- Ahealth insurance exchange is an online marketplace where consumers can compare and buy individual health insurance plans. … But consumers are only eligible to receive premium subsidies and cost-sharing reductions if they purchase their coverage through the exchange.
  2. Explaining about HIX and the opportunities
  3. What is an Exchange, how does it work, where and with whom exchange people work.
  4. What is State run and Federal run HIX.
  5. What are the different functions of the exchange –eligibility, enrollment, plan management, re- insurance and risk corridors?

Healthcare small topics:

  1. What is ICD? Why ICD-10? What are CPT Codes and HCPCS codes?
  2. What is HCFA-1500?
  3. What is UB04 Form?
  4. What are NCQA standards?
  5. What is MMIS of CMS? What do they do?
  6. Conversion means what?
  7. What is data mapping?
  8. What is ICD-9 to ICD-10 crosswalk?
  9. What are the online conversion tools?
  10. ICD-CM versus ICD-PCS à Clinical Unit versus Procedure Coding System
  11. Medical Loss Ratio
  12. Pharmacy Benefit Management

Provider sector and JAD session:

  1. BPMN Basics – Pools, Lanes, Event, Activity, Gateway, Sequence, Group, Annotation!
  2. EMR/EHR
  3. EMR Implementation Projects
  4. Revenue Cycle Management Projects
  5. JAD Session, Verifying Requirements after a JAD Session.
  6. One-on-One Meetings for Requirements: JAD Session Homework, Writing a JAD Session Agenda, JAD session inputs, Conducting a JAD Session, JAD Session Outputs, Recording draft requirements in Requirements management tool.

EDI and Claims :

  1. What are EDI transactions, different types, ANSI, ASCX12, EDIX12, Meanings, Uses and Formats of the following: HIPAA EDI 837, 834, 835, 820, 270, 271, 277, 278
  2. What are EDI implementation guides and EDI Companion guides? How to read them?
  3. How to write EDI requirements? What business rules do EDI transactions follow?
  4. What is an EDI transaction? What are the parts – loops, segments, delimiters etc?
  5. What is claims lifecycle? Who pays for claims & how is payment transmitted? What is Revenue Cycle Management

Course Curriculum

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