Revenue Cycle Management and Medical Billing for Advanced

Master advanced revenue cycle management (RCM) and medical billing for US healthcare. This course elevates your command of revenue cycle management, medical billing, AR management and A/R calling, prior authorization, advanced medical coding, enterprise payment posting, high-volume healthcare claims, and systemwide denial management. You’ll work directly with medical records to strengthen documentation and clean claims (CMS 1500, CMS 1450), align teams through leadership practices, and operationalize analytics and EDI workflows that move the needle on cash and compliance.

This course is designed to help experienced RCM professionals apply advanced strategies across payer contracting, pricing, documentation, EDI, and appeals—grounded in real operations, not theory. Whether you lead billing, coding, AR, payment posting, or revenue integrity, you’ll develop playbooks that scale from single practices to multi-site systems and MSOs. You’ll engineer the revenue cycle from governance to zero balance: design revenue integrity controls, stand up prior auth programs for high-cost services, optimize coding tied to medical necessity, build clean claims with payer-specific edits, and automate EDI/ERA reconciliation.

You’ll measure what matters—DNFB, clean-claim rate, first-pass yield, denial preventability, net collection rate—and drive predictable cash acceleration. Designed for advanced learners, this program uses case studies, datasets, appeal templates, contract math, and KPI scorecards. You’ll leave with reusable frameworks, queries, and checklists you can deploy immediately.

What You’ll LearnEstablish strategic revenue integrity & governance with policy and KPIsExecute advanced payer contracting analysis and underpayment recoveryNavigate payment methodologies (FFS, capitation, APC/DRG) and variance modelsOptimize risk adjustment, quality, and value programs for reimbursement liftLead advanced coding & documentation audits tied to medical necessityManage enterprise claims & EDI (837/835), edits, rejections, routing, SLAsBuild denial science programs with CARC/RARC mapping and appeals masteryDrive AR optimization & cash acceleration with worklists and aging strategiesCourse Features100+ advanced video lessons with artifacts (contracts, payer letters, ERAs, dashboards)Contract modeling worksheets and underpayment recovery calculatorsDenial taxonomies, root-cause trees, and appeal letter librariesEDI implementation checklists (837P/837I/835), edit logic and routing mapsPlaybooks for prior authorization, documentation capture, and payment posting reconciliationBI/analytics templates for KPIs (NCR, FPR, days in AR, avoidable denials)ESL-friendly explanations; mobile/desktop/tablet accessOrganized into 14 sections for focused mastery:Section 1 — Strategic Revenue Integrity & GovernanceSection 2 — Advanced Payer Contracting & Underpayment RecoverySection 3 — Payment Methodologies & Reimbursement SystemsSection 4 — Risk Adjustment, Quality & Value ProgramsSection 5 — Advanced Coding & DocumentationSection 6 — Specialty Expert TracksSection 7 — Enterprise-Scale Claims, EDI & ClearinghouseSection 8 — Denials Science & Appeals MasterySection 9 — AR Optimization & Cash AccelerationSection 10 — Patient Financial Experience & ComplianceSection 11 — Automation, Data & Engineering for RCMSection 12 — Audit, Compliance & SecuritySection 13 — Enrollment & Credentialing at ScaleSection 14 — Leadership, Operations & WorkforceWho This Course Is ForSenior billers/coders, AR managers, payment posting leadsRevenue integrity analysts and denial prevention leadersPractice administrators, MSO/DSO leaders, and health-system RCM teamsConsultants and BI analysts supporting payer and provider operationsProfessionals stepping into leadership roles in RCMAnyone driving enterprise medical billing transformation in US healthcareDisclosure: This course contains the use of artificial intelligence for clear voiceovers.