Revenue Cycle Management and Medical Billing for Advanced

Master Advanced Revenue Cycle Management (RCM) & Medical Billing

Elevate your expertise in US healthcare revenue cycle management with this comprehensive, advanced course. Go beyond the basics and gain mastery over critical areas including medical billing, AR management, and denial management.

Key Topics Covered:

• Advanced Medical Coding: Deep dive into complex coding scenarios and strategies.
• Prior Authorization: Develop and optimize prior authorization programs for high-cost services.
• Enterprise Payment Posting: Implement efficient and accurate payment posting workflows.
• High-Volume Healthcare Claims: Manage and optimize claims processing for large volumes.
• Systemwide Denial Management: Implement strategies to minimize denials and maximize revenue capture.
• Clean Claim Development: Master CMS 1500 and CMS 1450 claim submission requirements.
• EDI Workflows: Operationalize Electronic Data Interchange (EDI) for streamlined processing.
• Payer Contracting & Underpayment Recovery: Execute advanced payer contracting analysis and strategies for recovering underpayments.
• Risk Adjustment, Quality & Value Programs: Optimize programs for enhanced reimbursement.

What You'll Achieve:

• Strategic Revenue Integrity: Establish robust revenue integrity controls and governance.
• Data-Driven Decision Making: Utilize analytics and KPIs (Net Collection Rate, First-Pass Yield, Clean Claim Rate) to drive predictable cash acceleration.
• Claim Optimization: Build clean claims with payer-specific edits and improve claim acceptance rates.
• Denial Prevention: Develop denial science programs with CARC/RARC mapping and appeals mastery.
• Workflow Automation: Implement EDI/ERA reconciliation and automate key RCM processes.
• Scalable Playbooks: Create playbooks adaptable from single practices to multi-site systems and MSOs.

Course Features:

• 100+ Advanced Video Lessons: Featuring real-world artifacts like contracts, payer letters, and ERAs.
• Practical Tools: Contract modeling worksheets, underpayment recovery calculators, and denial taxonomies.
• EDI Implementation Resources: Checklists, edit logic, and routing maps for 837/835 transactions.
• BI/Analytics Templates: Pre-built dashboards for tracking key performance indicators (KPIs).
• ESL-Friendly Explanations: Accessible learning for all levels.
• Mobile & Desktop Access: Learn anytime, anywhere.
• Organized into 14 Focused Sections: For comprehensive mastery of RCM.

Course Sections:

1. Strategic Revenue Integrity & Governance
2. Advanced Payer Contracting & Underpayment Recovery
3. Payment Methodologies & Reimbursement Systems
4. Risk Adjustment, Quality & Value Programs
5. Advanced Coding & Documentation
6. Specialty Expert Tracks
7. Enterprise-Scale Claims, EDI & Clearinghouse
8. Denials Science & Appeals Mastery
9. AR Optimization & Cash Acceleration
10. Patient Financial Experience & Compliance
11. Automation, Data & Engineering for RCM
12. Audit, Compliance & Security
13. Enrollment & Credentialing at Scale
14. Leadership, Operations & Workforce

Who Should Take This Course?

• Senior Billers/Coders
• AR Managers
• Payment Posting Leads
• Revenue Integrity Analysts
• Denial Prevention Leaders
• Practice Administrators
• MSO/DSO Leaders
• Health-System RCM Teams
• Consultants & BI Analysts
• RCM Professionals Seeking Leadership Roles
• Anyone Driving Enterprise Medical Billing Transformation

Disclosure: This course utilizes artificial intelligence for clear voiceovers.