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Revenue Cycle Management and Medical Billing for Experts
Rating: 4.8 out of 5(5 ratings)
962 students
Created byRCM Academy
Last updated 10/2025
English

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.

Course content

6 sections • 29 lectures • 1h 39m total length

  • CDM governance 2.03:11
  • Strategic Pricing Models3:07

    Balance market benchmarks and elasticity by service line to set competitive, defensible pricing using percent of medicare, regional comp bands, and bundled versus ala carte options with annual refresh.

  • Cash-Pay & Financial Assistance Optimization2:56
  • Shoppable Services & Bundling3:02
  • Pricing Analytics & Elasticity Dashboard (Lab)3:14

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 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.

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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