Facets Business Analyst roles and responsibilities

Many readers ask me to explain the roles and responsibilities of a Healthcare Business Analyst especially in Facets Business Analyst. Well Facets business analyst and healthcare business analyst have very common similarities. Because Facets is a tool used only for Healthcare Insurance companies. In particular mainly BCBS (Bluecross blueshields, ..) will use Facets tool to process their commercial, Medicare, Medicaid claims.

So the basic question I am going to ask you is: What is the difference between Finance Industry & a Healthcare Industry?  very funny right? well, a finance company deals with finance related activities, where as a healthcare industry deals with Healthcare related activities.

Similarly a finance business analyst must have good knowledge of Finance domain and a Healthcare Business analyst must have a healthcare knowledge.

A facets business analyst must know excellent knowledge of Healthcare Industry.

Should have knowledge of how Medicare works and how Medicaid works.

Should know the differences of Hospital claims and Medical or professional claims.

Should know how Providers have contracts with Health insurance companies.

and apart from these, regular business analyst roles such as use case diagrams, documentation, conducting meetings, being a bridge between stake holders and developers/testers. etc..

Please let me know if you have any questions.

 

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