Facets Business Analyst Classroom Training and Certification Classes

• Accounting Applications
• Applications Support
• Billing Applications
• Capitation/Risk Allocation Applications
• Claims Processing Applications
• Criteria Maintenance Applications
• Customer Service Applications
• Dental Plan Applications
• Dental Provider Agreement Applications
• Medical Plan Applications
• Pricing Profile Applications
• Provider Applications
• Subscriber/Member Applications
• Utilization Management Applications

• Claims processing and pre-pricing
• Referral management
• Hospital and ambulatory pre-authorization
• Dental plan administration
• Case management
• Customer service
• Group/membership administration
• Plan/product and benefit calculations
• Provider network management
• Premium billing and receivables
• Capitation/risk fund accounting
• Medicare/Medicaid Risk processing
• Reporting

Medical, Dental and Hospital claims

HMO, PPO, Point of Service (POS) and indemnity

Either by electronically loading the claims in the system from an external source or by online data entry using claims logging application

• Unbundled procedures
• Invalid data relationships
• Deviation of outpatient and inpatient utilization patterns from generally accepted standards of clinical practice
• Inappropriate diagnoses for the patient’s gender/age
• Case management diagnoses

Diagnostic Related Grouping (DRG), Flat Fee Schedule, Conversion Factor and Room Type