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 Learn

• Establish strategic revenue integrity & governance with policy and KPIs

• Execute advanced payer contracting analysis and underpayment recovery

• Navigate payment methodologies (FFS, capitation, APC/DRG) and variance models

• Optimize risk adjustment, quality, and value programs for reimbursement lift

• Lead advanced coding & documentation audits tied to medical necessity

• Manage enterprise claims & EDI (837/835), edits, rejections, routing, SLAs

• Build denial science programs with CARC/RARC mapping and appeals mastery

• Drive AR optimization & cash acceleration with worklists and aging strategies

Course Features

• 100+ advanced video lessons with artifacts (contracts, payer letters, ERAs, dashboards)

• Contract modeling worksheets and underpayment recovery calculators

• Denial taxonomies, root-cause trees, and appeal letter libraries

• EDI implementation checklists (837P/837I/835), edit logic and routing maps

• Playbooks for prior authorization, documentation capture, and payment posting reconciliation

• BI/analytics templates for KPIs (NCR, FPR, days in AR, avoidable denials)

• ESL-friendly explanations; mobile/desktop/tablet access

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

Who This Course Is For

• Senior billers/coders, AR managers, payment posting leads

• Revenue integrity analysts and denial prevention leaders

• Practice administrators, MSO/DSO leaders, and health-system RCM teams

• Consultants and BI analysts supporting payer and provider operations

• Professionals stepping into leadership roles in RCM

• Anyone driving enterprise medical billing transformation in US healthcare

Disclosure: This course contains the use of artificial intelligence for clear voiceovers.