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

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.

Description
Master enterprise-level revenue cycle management (RCM) and medical billing for US healthcare.This expert program advancesrevenue cycle management,medical billing,prior authorization,medical coding,payment posting, high-complexityhealthcare claims,denial management, andAR management/AR calling—tied directly tomedical recordsand payer policy. You’ll operationalize pricing andCMS 1500/CMS 1450governance, design actuarialpayer contracting, engineerFHIR/X12integrations, and lead cross-functionalleadershipinitiatives 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 thechargemaster; align pricing to revenue economics

Executeactuarial contractingand underpayment recovery at scale

BuildFHIR/X12pipelines (837/835/270/271/277/278) and clearinghouse strategy

Operationalizepharmacy/PBMrevenue and340Bsplit-billing controls

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

Runvalue-basedoperations with quality/RAF and financial risk analytics

Stand updata science/MLOpsfor denials,AR, and cash forecasting

Governcybersecurity, privacy,audits, and enterpriseleadershippractices

Course Features

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

Interop blueprints:FHIR/X12mappings, edit taxonomies, routing, SLAs

Playbooks for340B, PBM, high-cost episodes, post-acute, and facility payment

DS/ML notebooks for denial prediction,ARaging, 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:

Pricing, Chargemaster Strategy & Revenue Economics

Advanced Payer Contract Actuarial Modeling

FHIR/X12 Interoperability Engineering

Pharmacy & PBM Revenue Cycle

340B Program & Split-Billing

Post-Acute & Facility Payment Systems

Who This Course Is For

Health-system executives,Revenue Cycledirectors/VPs, and enterprise RCM leaders

Senior consultants and actuaries working on payer/provider contracting

EDI/IT and data leaders implementingFHIR/X12and 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.

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
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