Medical Billing |RCM| US Health care

Name: Medical Billing |RCM| US Health care
Rating: 4.3 (22 reviews)

Medical Billing Concepts, Job Opportunities in Medical Billing, AR analyst part in detail

Created byAjay Tomar

Last updated 10/2025

English

English [Auto],

What you'll learn

Medical Billing Concepts, Job Opportunities in Medical Billing
Parties Involved in Medical Billing
Denial Analysis, Working on Unpaid Claims
Insurance Calling Scenarios
Charge Entry, Payment Posting, Revenue Cycle Management, Accounts Receivable
At last we will cover denial handling with example, denial mitigation plan
AR ageing review
Client KPI

Course content

7 sections • 44 lectures • 3h 14m total length

2024 Road map & Intro!0:42
Goal for this video is to understand the medical billing.
This course is designed keep in mind that beginner can understand the concept of medical billing and experienced professionals can also enhance their skill to groom his/her carrier in medical billing.
After completion of this course, you will be able to start your carrier in medical billing, experienced professionals’ chances become high for next level.
What you'll learn from the course?0:54
Medical Billing Concepts, Job Opportunities in Medical Billing
Parties Involved in Medical Billing
Medical Billing Cycle
Types of Insurances, Types of Health Insurance Plans, CMS1500, UB04
Denial Analysis, Working on Unpaid Claims
Insurance Calling Scenarios
Charge Entry, Payment Posting, Revenue Cycle Management, Accounts Receivable,
Comparison of treatment reimbursement in India vs US1:59
In India we generally do not prefer to go to doctor for fever, cough and cold we treat our self with the help of general medicine. Here the purpose of discussing the scenario to understand we deal in cash in India for medical bills.
In US People are serious about health conditions and for small-to-small disease they will reach out to there primary care physician. They generally don’t deal with cash; they deal with the insurance card.
Treatment reimbursement in India3:29
We deal in cash in every manner in OPD case.
How patient paid to healthcare provider/doctors?

Treatment reimbursement in US5:25
In US People are serious about health conditions and for small-to-small disease they will reach out to there primary care physician. They generally don’t deal with cash; they deal with the insurance card.
Treatment reimbursement in US
What is Medical Billing / US Health care2:21
The medical billing process is a process that involves a third-party payer, which can be an insurance company or the patient. Medical billing results in claims, which are billing invoices for medical services rendered to patients.
Quiz Related to Lecture 6
Entity who involved in medical billing4:34
1.Provider- also called doctors who provide the services to patient.
2.Patient- also called beneficiary who treated by the doctors.
3.Insurance companies- these are the corporate sectors who provide insurance plan to patient to become safe healthier at every point of time after paying an amount and plans depends upon the coverage and amount how much patient paid for.
4.Third parties- also call medical billing companies, who work on behalf of provider for getting reimbursement of bills for the services rendered to patient.
Entity who involved in medical billing add on0:29
Quiz from Lecture 7
Brief about entity in Medical Billing3:17
1.Provider- also called doctors who provide the services to patient.
2.Patient- also called beneficiary who treated by the doctors.
3.Insurance companies- these are the corporate sectors who provide insurance plan to patient to become safe healthier at every point of time after paying an amount and plans depends upon the coverage and amount how much patient paid for.
4.Third parties- also call medical billing companies, who work on behalf of provider for getting reimbursement of bills for the services rendered to patient.
Further classification of Third parties (Medical billing companies)1:31
depend upon the organization size, departments may vary.
Claim life cycle7:51
HCFA 1500 Form2:25
Health Care Financing Administration (HCFA). Also called as CMS 1500 Form.
Question related to HCFA 1500

Medical Billing Services Sales Representative1:48
Medical Billing Entity Finance Team3:07
Explore the finance team's role in medical billing and revenue cycle management (RCM), including budgeting, financial analysis, cost control, billing and collections, compliance, and strategic planning within healthcare settings.
Contact team or AE's (between doctors and medical billing company)2:20
Explore how the contact team, or AEs, bridge doctors and the medical billing company within RCM, outlining their role, responsibilities, and communication flow.
Transition Team2:42
Credentialing Team4:27
Enrollment Team2:06
Difference between credentialing and enrollment1:34
Explore the difference between credentialing and enrollment in medical billing, where credentialing certifies a provider’s qualifications and enrollment requests participation in the health insurance network; enrollment requires credentialing.
Coding Team4:17
Role and importance of the Coding Team
Claim building Team3:14
Claim submission (EDI Team)7:50
Payment posting Team & Correspondence Team6:44
AR follow up Team5:05
Discover how the AR follow up team converts unpaid claims into paid claims by following up with insurers, fixing denials, and supporting revenue cycle management in medical billing.
Patient statement team2:42
Patient services team1:52
Collection agency2:27

Introduction to EDI (Electronic data interchange)6:31
See how a claim form is built by the claim building and coding teams, and learn the two submission modes—paper and electronic with a payer ID via clearinghouses—toward understanding edi basics.
Mode of transmitting claim add on0:25
EDI-About accepted and rejected claims11:14
EDI Conclusion2:21
Explore how the EDI team handles internal clearing house and payer clearing house rejections, tracks accepted and rejected 837 files, and moves claims toward payment or denial.
Related to EDI

Introduction0:47
Internal clearinghouse transmits 837 files; if accepted by the payer, they proceed to the insurance company software and back to the internal clearinghouse, with rejected claims requiring edi team fixes.
Introduction of payment posting0:59
Learn how payment posting processes handle clearinghouse responses, posting paid or denied statuses, manual EOBs, and remittance downloads, while reconciling payments and reporting data.
Payment posting4:23
Explore the job role of the payment posting team and how they post paid or denied claims into the system from insurance responses and office correspondence.
Wrap up Payment posting1:25

Denial Introduction6:57
Explore denial handling within revenue cycle management, learn common terms and abbreviations such as EOB, CPT, ICD, EHR, and CMS, and prepare for remittance concepts in the next lecture.
How to Review EOB/ERA28:10
Learn how to read eob/era remittance details, identify payer processing, patient responsibility, and key terms like deductible, coinsurance, co-pay, and contractual adjustments.
Denial Look up tool4:17
Look up Tool- One place for you search for denial code and remark code with a toggle feature.
Converter- Now at same place you can calculate the patient age according to DOS, can convert the currency, and also time for scheduling your meeting according to different time zone.
Denial handling- This is the feature under development phase and soon from this tool you will be completely able to understand about the denial and how we can fix the denial and prevention measures.
Denial on the basis of Entity5:00
Explore denials in medical billing by understanding denial reasons tied to entities and coverage issues. Learn how to prevent future denials by reviewing denial types, eligibility checks, and software workflows.

Requirements

Can Speak, Write and understand basic English
Graduate from any stream
Can work on computer
No Prior Medical billing knowledge required

Description

You will learn all about RCM called Revenue cycle management/US Healthcare from beginning to end. This course is for BPO, KPO or person who willing to move their carrier in medical billing high demand market, can start immediate after their graduation from any stream.

You can be in any one of the fields after going through with the course. You can be in collection agency, Patient services team, Patient statement team, AR follow up team, Payment posting team, claim submission team, Charge/demographic entry team, can further learn coding and can be in coding team, can be in credentialling/enrolment team, transition team etc. According to knowledge and experience you can be in any team also according to your interest.

RCM/US Heath care is the vast field to learn, day by day world moving towards the quality of medication with the medical standards. US Healthcare is the one of the examples where every treatment coded in accordance with the coding guideline and every medication liable to paid by the insurance companies not by the patient 100%. This course will cover from beginning to till joining how you can grab a job in medical billing companies and will give you a brief out come about the salary slab and companies from where you can start your carrier.

Who this course is for:

Beginner
Recently Graduate
Looking for Jobs in Medical billing

Medical Billing |RCM| US Health care

What you'll learn

Explore related topics

Course content

Welcome to RCM Learning4 lectures • 7min

Introduction to US Healthcare8 lectures • 28min

Jobs and Role responsibilities of Entities involved in RCM15 lectures • 52min

Job Opportunity & Salary, brief about Claim Life Cycle5 lectures • 35min

EDI (Electronic Data Interchange)4 lectures • 21min

Payment posting4 lectures • 8min

Denials4 lectures • 44min

Requirements

Description

Who this course is for: