Master RCM & Medical Billing (Level 4 of 5) for expert medical billers: prior auth, EDI, CMS-1500/1450, denials, A/R
β±οΈ Length: 1.6 total hours
β 5.00/5 rating
π₯ 627 students
π October 2025 update
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- Course Overview
- This advanced certification course is meticulously designed for experienced medical billing professionals seeking to elevate their expertise and ascend to strategic leadership roles within healthcare revenue cycle management (RCM).
- Moving beyond foundational billing principles, this program delves into the intricacies of optimizing financial workflows, ensuring compliance, and leveraging technology for peak revenue performance.
- Participants will gain a comprehensive understanding of the entire revenue lifecycle, from patient registration and verification to claims submission, denial management, and account resolution, with a keen focus on complex scenarios and forward-thinking strategies.
- The curriculum is structured to equip individuals with the analytical acumen and operational proficiency required to navigate the evolving landscape of healthcare finance, including emerging payment models and regulatory demands.
- Emphasis is placed on developing a holistic approach to RCM, integrating clinical operations, information technology, and financial management to achieve sustainable financial health for healthcare organizations.
- The course utilizes a case-study driven methodology, incorporating real-world challenges and solutions to foster practical application of learned concepts.
- Upon successful completion, participants will be poised to implement transformative RCM strategies, drive significant improvements in financial performance, and assume leadership positions in their organizations.
- The program’s forward-looking approach ensures that attendees are prepared for the future of healthcare finance, including the increasing importance of data analytics and technological integration.
- Requirements / Prerequisites
- A minimum of 3-5 years of direct experience in medical billing, coding, or RCM operations is strongly recommended.
- Familiarity with standard medical billing forms (CMS-1500 and UB-04/CMS-1450) and their respective data fields.
- Basic understanding of payer adjudication processes and common billing rules.
- Proficiency in using Electronic Health Record (EHR) and Practice Management Systems (PMS) for billing functions.
- A foundational knowledge of HIPAA regulations pertaining to patient privacy and data security in healthcare.
- An analytical mindset and a demonstrated ability to problem-solve within a financial context.
- The capacity to engage with complex technical and regulatory information.
- Experience with basic financial reporting and reconciliation within a healthcare setting is advantageous.
- Skills Covered / Tools Used
- Strategic development and implementation of enterprise-wide RCM frameworks.
- Advanced techniques for contract modeling and analysis to identify and rectify reimbursement discrepancies.
- Expertise in interoperability standards for seamless data exchange between systems and clearinghouses.
- Proficiency in managing the financial intricacies of specialty programs such as 340B and integrated pharmacy services.
- Advanced strategies for the financial management of complex patient care episodes, including risk mitigation.
- Analytical skills for optimizing value-based care initiatives through data-driven insights.
- Development and deployment of data science pipelines for predictive analytics in RCM.
- Leadership and governance skills in healthcare cybersecurity and advanced compliance beyond HIPAA.
- Denial management and root cause analysis at an expert level.
- Accounts Receivable (A/R) optimization and effective collections strategies.
- Payer credentialing and enrollment best practices for maximizing network access.
- Patient financial experience optimization and engagement strategies.
- Auditing and compliance for revenue cycle integrity.
- Technology adoption and integration for RCM efficiency.
- Benefits / Outcomes
- Transform from a transactional biller to a strategic RCM leader capable of driving significant financial improvements.
- Gain the ability to architect and govern complex revenue cycles for diverse healthcare entities, including large hospital systems and integrated delivery networks.
- Develop a deep understanding of payer-provider financial dynamics, enabling effective negotiation and underpayment recovery.
- Become adept at leveraging cutting-edge technology and data analytics to proactively address financial challenges and identify growth opportunities.
- Enhance your capacity to lead and manage large-scale RCM operations, fostering efficiency and compliance across departments.
- Attain proficiency in navigating the financial complexities of emerging healthcare models, such as ACOs and value-based care arrangements.
- Elevate your career prospects to roles such as RCM Director, VP of Revenue Cycle, or Financial Operations Manager.
- Become a recognized expert in revenue integrity and financial stewardship within the healthcare industry.
- Empowerment to implement best-in-class RCM practices that directly impact an organization’s bottom line.
- Cultivate a proactive approach to financial risk management and compliance in a rapidly evolving regulatory environment.
- PROS
- Highly specialized and advanced curriculum tailored for experienced professionals, offering a significant competitive advantage.
- Focus on strategic thinking and leadership prepares individuals for higher-level RCM roles.
- Emphasis on emerging technologies and analytics ensures participants are at the forefront of industry trends.
- Comprehensive coverage of complex financial scenarios, providing practical solutions for challenging situations.
- CONS
- Due to its advanced nature, it may require a significant prerequisite knowledge base, potentially excluding individuals with less experience.
Learning Tracks: English,Business,Management
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