Global /US medical billing and coding, prior authorization, credentialing, Bill Payments and Medicare best practices
β±οΈ Length: 7.8 total hours
β 4.57/5 rating
π₯ 5,664 students
π January 2025 update
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- Course Overview
- This ‘Master in Healthcare Revenue Cycle Management (RCM)’ course provides a strategic, deep dive into optimizing the financial health of healthcare organizations, extending beyond foundational knowledge to advanced methodologies crucial for sustainable growth.
- Gain a comprehensive understanding of RCM’s strategic importance in impacting patient care quality, operational efficiency, and overall organizational profitability within a dynamic healthcare environment.
- Master the intricacies of global and US-specific medical billing and coding, prior authorization protocols, meticulous provider credentialing, efficient claims submission, and strategic accounts receivable management, ensuring robust compliance.
- Explore advanced strategies for managing complex payment landscapes, including in-depth analysis of Medicare best practices, commercial insurance negotiations, and patient payment responsibility to minimize revenue leakage.
- Understand and apply critical regulatory compliance frameworks such as HIPAA and MACRA, safeguarding processes against financial and reputational risks through ethical and legally sound practices.
- Learn to foster seamless interdepartmental collaboration across clinical, administrative, and financial teams, creating a unified and patient-centric revenue cycle that optimizes efficiency and enhances patient experience.
- Requirements / Prerequisites
- A foundational understanding of basic healthcare administrative processes or exposure to the healthcare industry is highly beneficial.
- Strong analytical skills and comfort with data interpretation are essential for analyzing financial metrics and performance indicators.
- Basic computer literacy and familiarity with common office software are expected for engaging with various digital tools and platforms.
- A proactive approach to continuous learning and a motivation to solve complex financial challenges within healthcare will enhance your learning experience.
- Skills Covered / Tools Used
- Strategic Financial Planning for RCM: Develop the capacity to formulate long-term financial strategies, aligning RCM initiatives with broader institutional goals for fiscal sustainability.
- Advanced Data Analytics and Reporting: Master techniques for extracting actionable insights from large datasets of claims, payments, and denials, utilizing intelligence for proactive decision-making.
- Payer Negotiation and Contract Optimization: Acquire advanced negotiation skills to effectively interact with insurance payers, resolve disputes, and optimize contract terms for maximum reimbursement.
- Compliance Auditing and Risk Mitigation: Learn to identify and mitigate compliance risks within the revenue cycle, implementing robust internal controls and conducting regular audits.
- Change Management for RCM Transformation: Gain expertise in leading organizational change related to RCM process improvements, technology adoption, and staff training.
- Project Management for RCM Initiatives: Apply structured project management methodologies to plan, execute, and monitor RCM optimization projects, ensuring timely delivery and target achievement.
- EHR/EMR and RCM Platform Integration: Understand how to leverage seamless integration between Electronic Health Records and RCM systems for automated data flow, improved accuracy, and reduced manual effort.
- Ethical Decision-Making in Billing: Cultivate a strong ethical framework for all billing and collection practices, ensuring transparency, fairness, and patient advocacy.
- Benefits / Outcomes
- Elevated Career Trajectory: Position yourself for leadership roles such as RCM Manager, Billing Director, or Healthcare Financial Analyst, with a highly valued specialized skill set.
- Significant Financial Impact: Become instrumental in improving organizational financial health by reducing denial rates, accelerating cash flow, increasing collection rates, and optimizing operational costs.
- Enhanced Operational Efficiency: Drive improvements in administrative workflows, minimize errors, and streamline processes from patient registration to final payment.
- Improved Patient Financial Experience: Contribute to a more transparent and empathetic patient billing journey, fostering greater patient satisfaction and trust.
- Adaptability to Evolving Regulations: Gain confidence to navigate continuously changing healthcare regulations, payment models, and technological advancements, ensuring ongoing compliance.
- Global Employability: With a curriculum covering both US and global billing standards, your expertise will be sought after by healthcare providers and consulting firms worldwide.
- Strategic Problem-Solving: Develop the ability to diagnose complex RCM challenges, devise innovative solutions, and implement effective strategies yielding measurable improvements.
- PROS
- High Demand Skill Set: Healthcare RCM professionals are in constant high demand, ensuring robust career opportunities and job security in a growing industry.
- Immediate Practical Application: Content is designed for real-world scenarios, allowing direct application of new knowledge to current roles or quick transition into new ones.
- Expert-Led and Up-to-Date Content: January 2025 update ensures the most current best practices, regulatory changes, and technological advancements are covered.
- Comprehensive Coverage: Exhaustive overview of critical RCM components from global/US medical billing to Medicare best practices.
- Flexible Learning: Concise yet thorough 7.8-hour online format allows for learning at your own pace.
- Positive Peer Validation: A high 4.57/5 rating from over 5,600 students reflects the course’s effectiveness and value.
- CONS
- Continuous Learning Required: The healthcare revenue cycle landscape is subject to frequent regulatory and technological changes, necessitating ongoing self-study and adaptation beyond the course material.
Learning Tracks: English,Business,Management
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