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Revenue Cycle Management and Medical Billing for Experts

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0(306 students)

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About this course

Master enterprise-level revenue cycle management (RCM) and medical billing for US healthcare. This expert program advances revenue cycle management, medical billing, prior authorization, medical coding, payment posting, high-complexity healthcare claims, denial management, and AR management/AR calling—tied directly to medical records and payer policy. You’ll operationalize pricing and CMS 1500/CMS 1450 governance, design actuarial payer contracting, engineer FHIR/X12 integrations, and lead cross-functional leadership initiatives that accelerate cash, reduce risk, and scale outcomes across systems, MSOs, and digital health.

This course is designed to help senior RCM leaders apply expert strategies across pricing, contracts, documentation, pharmacy/340B, interoperability, post-acute, and litigation support—grounded in real operations, not theory. Whether you direct billing, coding, AR, pharmacy revenue, or enterprise EDI, you’ll build operating models, data pipelines, and governance that scale. You’ll engineer the enterprise revenue engine: optimize chargemaster, model payer contracts actuarially, integrate PBM/340B, standardize complex episodes (transplant, NICU, behavioral health, SUD), and deploy FHIR/X12 with edit orchestration and SLA routing.

Drive value-based ops (ACO/MSO/IPA), forecast denials/AR with ML, and harden privacy/security beyond HIPAA. What You’ll LearnPrice, govern, and audit the chargemaster; align pricing to revenue economicsExecute actuarial contracting and underpayment recovery at scaleBuild FHIR/X12 pipelines (837/835/270/271/277/278) and clearinghouse strategyOperationalize pharmacy/PBM revenue and 340B split-billing controlsManage post-acute & facility payment systems; lead complex episodes (NICU/transplant)Run value-based operations with quality/RAF and financial risk analyticsStand up data science/MLOps for denials, AR, and cash forecastingGovern cybersecurity, privacy, audits, and enterprise leadership practicesCourse Features120+ expert lessons with templates: pricing models, contract math, payer lettersInterop blueprints: FHIR/X12 mappings, edit taxonomies, routing, SLAsPlaybooks for 340B, PBM, high-cost episodes, post-acute, and facility paymentDS/ML notebooks for denial prediction, AR aging, and payment posting varianceCompliance toolkits: risk registers, audit trails, privacy controls, incident workflowsOps system artifacts: org design, KPIs, incentives, OKRs, and governance dashboardsAccessible on mobile, desktop, or tabletOrganized into 6 sections for focused mastery:Pricing, Chargemaster Strategy & Revenue EconomicsAdvanced Payer Contract Actuarial ModelingFHIR/X12 Interoperability EngineeringPharmacy & PBM Revenue Cycle340B Program & Split-BillingPost-Acute & Facility Payment SystemsWho This Course Is ForHealth-system executives, Revenue Cycle directors/VPs, and enterprise RCM leadersSenior consultants and actuaries working on payer/provider contractingEDI/IT and data leaders implementing FHIR/X12 and analytics at scalePharmacy/340B, PBM, and specialty program leadersCompliance, privacy, and audit leaders aligning RCM with enterprise riskM&A/roll-up operators integrating multi-site RCM platformsDisclosure: This course contains the use of artificial intelligence for clear voiceovers.

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Level: All Levels

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Duration: Self-paced

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Revenue Cycle Management and Medical Billing for Experts

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