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Course Description

Understanding health claims data is vital in supporting clinical and financial decision making for a broad spectrum of organizations including insurance companies, healthcare providers, and employers. Risk-sharing contracts between insurers and providers and changes to provider reimbursement are all part of a larger effort to control healthcare costs without sacrificing quality. The key to accomplishing this is distilling actionable and accurate information from the massive amount of data that both government and private insurers create with every encounter between patient and provider. This course focuses on basic data elements that exist in a health insurance claims, and how that information can be used for purposes of population management, quality improvement, financial reimbursement and modeling, and ultimately bending the upward trending cost curve that is looming over the entire healthcare system. This course is ideal for any student interested in a career in managed care or healthcare administration. This course will teach students about the concepts and students are expected to complete analyses using Excel. Students may choose to enroll in this course alone or couple it with PH0237 for more advanced applications.