Revenue Cycle Management and Medical Billing for Experts

Master RCM & Medical Billing (Level 4 of 5) for expert medical billers: prior auth, EDI, CMS-1500/1450, denials, A/R

Description

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 Learn

• Price, govern, and audit the chargemaster; align pricing to revenue economics

• Execute actuarial contracting and underpayment recovery at scale

• Build FHIR/X12 pipelines (837/835/270/271/277/278) and clearinghouse strategy

• Operationalize pharmacy/PBM revenue and 340B split-billing controls

• Manage post-acute & facility payment systems; lead complex episodes (NICU/transplant)

• Run value-based operations with quality/RAF and financial risk analytics

• Stand up data science/MLOps for denials, AR, and cash forecasting

• Govern cybersecurity, privacy, audits, and enterprise leadership practices

Course Features

• 120+ expert lessons with templates: pricing models, contract math, payer letters

• Interop blueprints: FHIR/X12 mappings, edit taxonomies, routing, SLAs

• Playbooks for 340B, PBM, high-cost episodes, post-acute, and facility payment

• DS/ML notebooks for denial prediction, AR aging, and payment posting variance

• Compliance toolkits: risk registers, audit trails, privacy controls, incident workflows

• Ops system artifacts: org design, KPIs, incentives, OKRs, and governance dashboards

• Accessible on mobile, desktop, or tablet

• Organized into 6 sections for focused mastery:

  1. Pricing, Chargemaster Strategy & Revenue Economics

  2. Advanced Payer Contract Actuarial Modeling

  3. FHIR/X12 Interoperability Engineering

  4. Pharmacy & PBM Revenue Cycle

  5. 340B Program & Split-Billing

  6. Post-Acute & Facility Payment Systems

Who This Course Is For

• Health-system executives, Revenue Cycle directors/VPs, and enterprise RCM leaders

• Senior consultants and actuaries working on payer/provider contracting

• EDI/IT and data leaders implementing FHIR/X12 and analytics at scale

• Pharmacy/340B, PBM, and specialty program leaders

• Compliance, privacy, and audit leaders aligning RCM with enterprise risk

• M&A/roll-up operators integrating multi-site RCM platforms

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

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