Healthcare Domain Specialization Course for IT
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 & Course Activities
Key Features
Designed for practical, job-oriented learning.
25+ Hrs Instructor-Led Online Training
Certification & Job Assistance
Flexible Schedule
24 x 7 Lifetime Support
100% Job Oriented Training
Work on Real-time Projects
Course Activities
Activities focused on career preparation.
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
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
Clearing House integration with Payer for 837p and 276 transactions includes X12, data mapping, companion and implementation guides
PAPI to NPI Conversion
PAPI to NPI conversion using LUHN algorithm
Member Website Use Case Modeling
Member website use case modeling
Enterprise Imaging Systems
Enterprise imaging systems conversion of paper claims to electronic forms
Microsoft HealthVault Integration
Microsoft health vault integration with third party wellness services
Open EMR Reverse Engineering
Open EMR reverse engineering
What Our Students Say
Hear from students who experienced Healthcare, BA and QA training with Yes-M Systems.
“I chose Yes M Systems to get training for BA and Healthcare classes.”
“I took QA, BA and Health care domain course.”
“I have taken Healthcare QA class with them. Class is very informative and helpful for me.”
“After taking QA, I took a 25 hour Healthcare class. Both were awesome classes.”
“Especially Healthcare training is simply the best training with real time scenarios.”
“Hi, the training and the instructor are awesome and very detail oriented and able to clear all my queries.”
“I have taken several other courses including QA/BA, ISTQB, Healthcare and Mobile testing classes.”
“Yes-M systems trained me as ‘Business Analyst’ and gave me a training in domain ‘Healthcare’ too.”
Ready to Build Your Healthcare Domain Skills?
Join the 25+ hour Healthcare Domain Specialization Course and gain practical knowledge through classes, assignments and project work.
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.



