Claims Data 101 Course

Practical introduction to claims. Ideal for all healthcare backgrounds, this course covers what claims are, why they exist, and how to most effectively use them.
David Ricupero, Business Development at Affect Therapeutics
"This course demystifies claims and makes you leave with a solid understanding."
Zarrah Birdie, Senior Director, Strategic Innovation & Business Development @ McKesson
"Fantastic introduction to healthcare claims, de-mystifies core concepts with tangible examples"
Chad Jackson, Director of Product at Kroger New Ventures
Our team of 4 data scientists took the Claims 101 course together and really enjoyed it. The content was helpful and very applicable to our work. The course was also well-run and thoughtfully executed!
Ovais Quraishi, Head of Engineering at VyncaCare
This course was the first professional learning experience that made me go wow... It helped me be much more fluent in speaking with various practitioner backgrounds.
David Ricupero, Business Development at Affect Therapeutics
"This course demystifies claims and makes you leave with a solid understanding."
Zarrah Birdie, Senior Director, Strategic Innovation & Business Development @ McKesson
"Fantastic introduction to healthcare claims, de-mystifies core concepts with tangible examples"
Chad Jackson, Director of Product at Kroger New Ventures
Our team of 4 data scientists took the Claims 101 course together and really enjoyed it. The content was helpful and very applicable to our work. The course was also well-run and thoughtfully executed!
Ovais Quraishi, Head of Engineering at VyncaCare
This course was the first professional learning experience that made me go wow... It helped me be much more fluent in speaking with various practitioner backgrounds.
David Ricupero, Business Development at Affect Therapeutics
"This course demystifies claims and makes you leave with a solid understanding."
Zarrah Birdie, Senior Director, Strategic Innovation & Business Development @ McKesson
"Fantastic introduction to healthcare claims, de-mystifies core concepts with tangible examples"
Chad Jackson, Director of Product at Kroger New Ventures
Our team of 4 data scientists took the Claims 101 course together and really enjoyed it. The content was helpful and very applicable to our work. The course was also well-run and thoughtfully executed!
Ovais Quraishi, Head of Engineering at VyncaCare
This course was the first professional learning experience that made me go wow... It helped me be much more fluent in speaking with various practitioner backgrounds.

Things You'll Get From This Course

Context on Claims

Acquire a strong foundation for why claims exist, when they make sense to use, and how to get the most of claims.
1

Real Case Studies

Hear from leading experts on how they have successfully used and powered their business with claims.
2

Hands on Assignments

Learn by doing with accessible, rich assignments that augment course content and are not found anywhere else in the industry.
3

Community Learning

Join and learn with diverse, high-caliber, and curious industry professionals via Slack and events.
4

Meet Your Instructor, Vishnu Rachakonda

Vishnu is a senior data scientist at firsthand, a company creating an in-person, peer-driven model for recovery from serious mental illness. As firsthand’s first data hire, he has helped scale the company’s impact to multiple states and thousands of individuals. With 6+ years of experience across clinical, claims, and medical imaging, Vishnu is passionate about realizing the power of data in healthcare.

Vishnu Rachakonda

Vishnu is a senior data scientist at firsthand, a company creating an in-person, peer-driven model for recovery from serious mental illness. As firsthand’s first data hire, he has helped scale the company’s impact to multiple states and thousands of individuals. With 6+ years of experience across clinical, claims, and medical imaging, Vishnu is passionate about realizing the power of data in healthcare.

Course Syllabus & Schedule

Module 1

Day 1

Introduction to Claims

(6/24, 7-830 PM EST)

We’ll start by introducing what a claims are, how claims came to exist in the US, and why claims are useful in place of or alongside clinical data. We’ll close with an assignment that walks you through the claim generation process in more detail and has you fill out a sample claim for an example healthcare encounter.

Module 2

Day 2

The Fundamentals of Claims

(6/26, 7-830 PM EST)

Building on day 1, we’ll go deeper into the different types of claims forms, the discrepancies that arise as claims get submitted to insurance companies via EDI, and how those challenges manifest in claims data that you’ll ultimately work with.

Module 3

Day 3

Claims Datasets

(7/1, 7-830 PM EST)

Here, we’ll get into the nuts and bolts of eligibility files, medical claims, and pharmacy claims datasets. We’ll talk about what each contains and what to look out for, and then close with an assignment around using Medicare’s BCDA synthetic claims dataset to answer tactical questions using claims data.

Module 4

Day 4

Making Claims Useful

(7/2, 7-830 PM EST)

Finally, we’ll close with several real life case studies on how to use claims data in practice. A few examples will include encounter modeling for understanding ED utilization, modeling health conditions to understand risk of members developing type 2 diabetes, and constructing cost profiles to understand the expenditures of patients with acute events triggered by COPD. We’ll have guest speakers to help us unpack each example and add context from their years of experience.

Module 5

Day 5

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Module 6

Day 6

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Module 7

Day 7

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Module 8

Day 8

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Module 9

Day 9

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Module 10

Day 10

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Frequently Asked Questions

Who is this course for?

Anyone looking to understand the foundations of healthcare claims and how to start effectively using them in healthcare settings. This includes data scientists, product manager, strategy leads, and ops owners whose work relies on healthcare claims. Past attendees have included:

  • Claims data scientists and engineering leaders (e.g. SVP of engineering at DaVita-backed company)
  • Strategic partnership leads (e.g. Partnerships lead at Series B Startup)
  • Clinician informaticists and physicians (e.g. Informatics Director / Pediatrician at top children’s hospital)
  • Sales & Business development leaders (Sr. Director of Strategic Innovation at Fortune 10 healthcare company)

How much is it?

The current price for the course is $1800. For corporate bulk discounts, email us at vishnu@outofpocket.health

Do I have to be at every session? How long are they?

Each session is 1.5 hours, and the course is comprised of 4 sessions. Recordings will be available the night after the session, but you’ll get a lot more from engaging live, asking questions, and being there for the interactive parts.

Will I be a claims expert after finishing this course?

No. We’ll teach you the foundations of claims and how to get started, but becoming proficient with claims takes years of learning. However, we do fully expect that you will be able to engage with any material that arises about claims at your organization or beyond, and learn more if you wish to do so.

Is there a lot of work?

We really believe you will get out what you put in. You could just watch the lectures and still learn something, but we very intentionally curated pre-reads and designed assignments that would help you truly grasp what we introduce in the lectures.

I have another question not answered here

Email us at vishnu@outofpocket.health and we'll get back to you ASAP.

Claims, but understandable