Business Analytics
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Business Analytics
Introduction to Business Analysis
Introduction to Projects
Relationship between Operations and Projects
Who is a Project Manager?
What is Business Analysis?
Who is a BA? BA Roles and Responsibilities
Competencies of a Business Analyst
Relationship between a BA and PM
Business Analysis Body of Knowledge
Career Path for a Business Analyst
What’s the goal? What is being analyzed?
Current Trends in Business Analysis
The Practice of Business Analysis
Differentiating Business Analysis and other “Analyst” roles
Customer Needs & IT Needs
The Skill Set Of A BA
The BA’s Core Knowledge Set
What the BA does not do!
Dark side of Business Analysis
Organization Structure and Reporting Relationships Tailoring the business analyst role for different projects
Tailoring the business analyst role for different projects
Software Development Life Cycle(SDLC)
What is SDLC?
Various stages of SDLC
SDLC Methodologies
Waterfall Model
Iterative and Incremental approach
Software Development Methodologies
What is a SW Development Methodology?
Why Software Methodologies?
Incremental and Iterative Approach
Water Fall Methodology
Prototype Methodology
Spiral Methodology
Agile Methodology
Rational Unified Process (RUP)
Diagnosing the Business Environment – Enterprise Analysis
SWOT Analysis
Feasibility Study & Analysis
Problem Statement & Goal Statement
Business Case
Project Scope Statement & Vision Document
AS IS (current state) and TO BE (future state) Modeling
Root Cause Analysis – Fish Bone Diagram
Landscape of Requirements
Requirements, Features And Constraints
Types Of Requirements – Functional & Non-functional
User and System Requirements
Requirements Source, Audience And Approval
Stakeholder Analysis & Management
Who are Stakeholders?
Stakeholders, Stakeholder categories and Profiles
Internal & External Stakeholders
Stakeholder Roles & Responsibilities
Conducting Stakeholder Analysis & Elicitation Plan
Requirements Elicitation
Requirements Gathering
Requirements Gathering Techniques
Selecting the appropriate technique
Challenges with Elicitation
The Elicitation Cycle
Requirements Analysis
Evaluating, Selecting and Prioritizing initiatives
Employing Analysis techniques to assess alternatives
Building a Model of the Solution – Business Process & Data Process Flow
Understanding & Developing Story BoardsDeveloping output mockups or prototypes
Obtaining Stakeholder confirmation
Constructing context, overview, and detail flow diagrams
Identifying appropriate detail levelData Requirements
Decision Trees and Decision Tables
Requirements Development Plan
Requirements Development Plan
Selecting Requirements development templates Organizing the Facts
Business Rules
User Attributes
Flowcharts
Use Case & Unified Modeling Language
What is Use case?
Basic Flow, Alternate Flows & Exception Flows
How Use Case Diagrams Show Relationships
Paths and Scenarios
Use Case Diagrams
Class Diagrams
Sequence Diagrams
Activity Diagrams
Introduction to Rational Suite & MS Vision
Requirements Management
Change Management
An examination of why people resist change
How Requirements become Un-Managed
BA’s role in managing change
Requirements Traceability & Change Control
When Requirements Collide: Alternative Decision-Making Approaches
How much time should be spent on Requirements
Implementing Just enough Requirements
Requirements Communication
Preparing and making the presentation
Description of solution
Establishing your objective
Doing audience analysis
Organizing your ideas
Using visuals
Rehearsing
Supporting Downstream Development
Quality Assurance and Quality Control
Business Analyst’s Role in Testing
Use Case vs Test Case
Responsibilities
How can the solution be evaluated?
Who should perform an assessment?
Requirements Validation Techniques
Unit Testing, System Testing, Integration Testing, Regression Testing
Flow Modeling
Business Process Flow
Data Process Flow
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)
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
PMP Course Outline
1 - Examining Professional Project Management
Identify Project Management Processes
Identify Professional and Social Responsibilities
Identify the Interpersonal Skills Required for a Project Manager
2 - Initiating a Project
Examine the Project Management Context
Examine Project Selection
Prepare a Project Statement of Work
Create a Project Charter
Identify Project Stakeholders
3 - Planning Project Work
Identify Elements of the Project Management Plan
Document Stakeholder Requirements
Create a Scope Statement
Develop a Work Breakdown Structure
4 - Developing Project Schedules
Create an Activity List
Create a Project Schedule Network Diagram
Estimate Activity Resources
Estimate Duration for Project Activities
Develop a Project Schedule
Identify the Critical Path
Optimize the Project Schedule
Establish a Schedule Baseline
5 - Developing Cost Estimates and Budgets
Estimate Project Costs
Estimate the Preliminary
Cost Baseline
Reconcile Funding and Costs
6 - Planning Project Quality, Staffing, and Communications
Create a Quality Management Plan
Document the Project Roles, Responsibilities, and Reporting Relationships
Create a Communications Management Plan
7 - Analyzing Risks and Planning Risk Responses
Examine a Risk Management Plan
Identify Project Risks and Triggers
Perform Qualitative Risk Analysis
Perform Quantitative Risk Analysis
Develop a Risk Response Plan
8 - Planning Project Procurement
Plan Project Procurements
Prepare a Procurement Statement of Work
Prepare a Procurement Document
9 - Executing Project Work
Identifying the Direct and Manage Project Execution Process
Execute a Quality Assurance Plan
Acquire the Project Team
Develop the Project Team
Manage the Project Team
Distribute Project Information
Manage Stakeholder Relationships and Expectations
10 - Managing Project Procurement
Identify the Conduct Project Procurements Process
Obtain Responses from Sellers
Determine Project Sellers
11 - Monitoring and Controlling Project Work
Identify the Monitor and Control Project Work Process
Develop an Integrated Change Control System
Utilize the Integrated Change Control System
Review Deliverables and Work Results
Control the Project Scope
12 - Monitoring and Controlling Project Schedule and Costs
Control the Project Schedule
Control Project Costs
13 - Monitoring and Controlling Project Performance and Quality
Perform Quality Control
Report on Project Performance
14 - Monitoring and Controlling Project Risk and Procurements
Monitor and Control Project Risk
Administer Project Procurements
15 - Closing the Project
Close Project Procurements
Close the Project or Phase Administratively