What You'll Learn
- Architect enterprise revenue cycle management strategy and revenue integrity.
- Model payer contracts actuarially; detect underpayments and maximize reimbursement.
- Engineer FHIR/X12 interoperability, edits, and clearinghouse routing at scale.
- Operationalize 340B and split-billing; integrate pharmacy/PBM revenue cycle.
- Lead complex episodes (transplant, NICU, behavioral health, SUD) with risk controls.
- Drive value-based care ops (ACO/MSO/IPA) with quality, RAF, and leakage analytics.
- Build data science/MLOps pipelines for denials, AR management, and forecasting.
- Govern cybersecurity/privacy beyond HIPAA; lead RCM leadership and change.
Requirements
- 3+ years in RCM/medical billing with team or project leadership experience.
- Command of medical coding, prior authorization, payment posting, and healthcare claims.
- Working knowledge of CMS-1500/CMS-1450, ERA/EOBs, edits, appeals, and payer policy.
Who This Course is For
- Directors/VPs of Revenue Cycle, AR management, and enterprise billing.
- Senior consultants building payer, pricing, actuarial, and value-based programs.
- EDI/IT leaders implementing FHIR/X12 integrations and clearinghouse strategy.
- Pharmacy revenue leaders, 340B managers, and PBM operations heads.
- Health-system leaders managing high-cost episodes, post-acute, and facility payment.
- Security/compliance leaders aligning RCM with audits, privacy, and risk assurance
Your Instructor
RCM Academy
Master Healthcare RCM & Medical Billing with RCM Academy
4.4 Instructor Rating
905 Reviews
12,961 Students
31 Courses
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Revenue Cycle Management and Medical Billing for Beginners
Master Revenue Cycle Management (RCM), Medical Billing, Insurance, AR, Denial Management, and Payme…
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