Master RCM & Medical Billing (Level 2 of 5): Intermediate skills in prior auth, coding, CMS-1500/1450, EDI, denials, A/R
β±οΈ Length: 2.1 total hours
π₯ 46 students
Add-On Information:
Get Instant Notification of New Courses on our Telegram channel.
Noteβ Make sure your ππππ¦π² cart has only this course you're going to enroll it now, Remove all other courses from the ππππ¦π² cart before Enrolling!
- Course Overview
- This intermediate-level course on Revenue Cycle Management and Medical Billing provides a pivotal progression for professionals aiming to transcend basic understanding and master the strategic complexities of healthcare finance. It intricately explores the interconnected RCM phases, from patient access to claim resolution, emphasizing how each step impacts an organization’s financial health. Rather than a mere review, this module cultivates an analytical and proactive mindset, moving participants from task execution to critical problem-solving in a dynamic healthcare environment. You will gain a deeper appreciation for the regulatory landscape, technological integrations, and best practices that define modern U.S. healthcare billing, positioning you to confidently navigate and optimize revenue streams. This program bridges the gap between foundational knowledge and autonomous execution, enabling you to identify inefficiencies, implement improvements, and significantly contribute to organizational financial stability and operational excellence.
- Requirements / Prerequisites
- A solid foundational understanding of core Revenue Cycle Management (RCM) principles and basic medical billing processes is essential. Participants should be comfortable with fundamental healthcare terminology, common insurance concepts (e.g., deductibles, co-pays), and the basic patient-to-billing flow.
- Prior exposure to standard healthcare administrative procedures, including patient registration and basic medical recordkeeping, is highly beneficial. A fundamental grasp of HIPAA and its implications for patient data privacy is also expected.
- This course targets individuals who have completed an introductory RCM/billing course or possess at least 6-12 months of entry-level experience. It is for those eager to embrace more analytical responsibilities and proficiently address multifaceted RCM challenges. Basic computer literacy is required.
- Skills Covered / Tools Used
- Develop advanced claim scrubbing and validation techniques, proactively identifying and rectifying potential errors to minimize denials. Master interpreting payer-specific adjudication rules for clean claim submission.
- Strategically navigate complex payer portals for prior authorization, understanding detailed medical necessity criteria and developing persuasive appeals for initial denials. This includes effective communication with clinical staff and insurance representatives.
- Apply sophisticated medical coding, including appropriate modifier usage, understanding unlisted procedure codes, and discerning professional vs. facility coding. Focus on coding for complex scenarios, ensuring compliance with official guidelines, and performing internal audits for accuracy.
- Enhance A/R management skills through strategic follow-up workflows for aging accounts, crafting compelling appeal letters, and conducting ethical yet persistent A/R calling. Learn to prioritize accounts based on aging, value, and payer responsiveness.
- Implement advanced denial prevention strategies using root-cause analysis to identify systemic issues. Develop internal training materials and utilize key performance indicators (KPIs) to continuously monitor and improve denial rates proactively.
- Conceptualize interaction with essential RCM tools like Electronic Health Records (EHR), Practice Management (PM) systems, electronic clearinghouses, and payer web portals. Emphasize data analysis from RCM reports to identify trends, pinpoint inefficiencies, and inform strategic operational improvements.
- Benefits / Outcomes
- Prepare for accelerated career advancement into roles such as Senior Medical Biller, RCM Specialist, or Denials Management Coordinator. Your enhanced skill set will make you an invaluable asset capable of managing complex financial operations.
- Contribute to significant improvements in organizational cash flow, reduced accounts receivable days, and a marked decrease in claim denial rates, directly enhancing the financial stability and operational efficiency of your healthcare provider.
- Gain profound confidence in navigating intricate payer rules, resolving challenging billing disputes, and implementing proactive strategies that prevent revenue leakage, empowering you to tackle complex RCM scenarios autonomously.
- Equip yourself to leverage data, automation principles, and analytical insights to continuously refine revenue cycle operations, driving sustainable financial growth and ensuring the long-term viability of healthcare practices.
- Ultimately, your mastery of these intermediate RCM skills will elevate your professional standing and contribute to a smoother, more transparent billing experience for patients, enhancing satisfaction through fewer discrepancies and quicker resolutions.
- PROS
- Targeted Skill Enhancement: Specifically hones intermediate RCM and medical billing skills, filling the gap between foundational knowledge and advanced specialization.
- Immediate Practical Application: Delivers knowledge directly transferable and actionable in real-world healthcare administrative roles, leading to immediate job performance improvements.
- Efficient Learning Path: As “Level 2 of 5,” it offers a structured and progressive learning journey, building logically upon prior RCM knowledge.
- Problem-Solving Focus: Emphasizes analytical thinking and root-cause identification for common revenue cycle challenges, fostering a proactive approach to issue resolution.
- Career Advancement Catalyst: Equips learners with expertise needed to pursue more senior or specialized roles within medical billing and RCM departments.
- Optimized Financial Performance: Provides strategies and techniques to significantly improve a healthcare organization’s cash flow, reduce denials, and enhance overall financial health.
- CONS
- Limited Hands-On Simulation: Given its concise duration, the course may primarily focus on conceptual and procedural understanding, potentially offering fewer extensive practical exercises or deep dives into specific software simulations, which might require learners to seek additional real-world experience for mastery.
Learning Tracks: English,Business,Management
Found It Free? Share It Fast!