This highly-rated course boasts a 0.0-star-star rating from 0 reviews and has successfully guided 249 students in mastering Operations skills. Featuring 2 hour(s) of expert-led content delivered in English, this course offers thorough training to enhance your Social Science expertise. The course details were last updated on December 24, 2024. This coupon code is brought to you by Anonymous.
- Expires on: 2025/11/02
- Last Update: October 29, 2025
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Price:
94.99 $0 $
About This Course
This course is designed to help learners of all backgrounds understand and apply claim scrubbing and rule-engine techniques in medical billing and revenue cycle management (RCM) in real-world healthcare settings. Whether you’re working in medical coding, billing, administration, Healthcare IT, or compliance, this course emphasizes HIPAA, HITECH, Business Associate Agreements (BAA), data protection, data safety, insurance rules, and payer compliance—with hands-on practice building edits, validations, and rule engines that boost first-pass clean-claim rates.
You’ll learn how claim data quality is built using standardized fields, code sets, and validation logic—then apply a structured taxonomy of rules (demographics, eligibility, coding/bundling, medical necessity, frequency, prior auth, POS/TOB, COB) to intercept issues before submission. The course also covers interoperability and EDI—including how to interpret the feedback loops from 837/999/277CA/835—and how to translate payer guidance (e.g., NCCI, LCD/NCD) into operational rules.
Designed to be beginner-friendly, this course offers clear explanations, interactive exercises, and realistic examples from EHRs, claim files, payer responses, and billing documentation to help reinforce learning. No prior medical knowledge is needed.
What You’ll Learn
Understand the structure and components of high-quality claims and pre-bill edits
Learn rule-design patterns for demographics, coding, bundling, and medical necessity
Recognize terms used in payer edits, clearinghouse rejections, and denial codes
Apply claim scrubbing in clinical, coding, billing, and administrative contexts
Interpret chart notes, EDI acknowledgments, and payer responses with confidence
Strengthen communication across billing, compliance, and Healthcare IT teams
Prepare for roles in claim scrubbing, denial prevention, revenue integrity, or RCM analytics
Course Features
35 video lessons organized by workflow, edit taxonomy, and system integration
Systematic breakdown of rules & edits with real-life examples and test cases
Focus on high-impact scenarios (NCCI, LCD/NCD, frequency, modifiers, prior auth)
Easy-to-follow format, suitable for all learners—including ESL students
Accessible on mobile, desktop, or tablet
Who This Course Is For
Aspiring and current billers, coders, and RCM analysts focused on prevention
Practice managers and owners seeking higher first-pass rates and lower rework
Healthcare IT/compliance professionals implementing HIPAA/HITECH and BAAs
Anyone entering medical billing who needs practical, automation-ready skills
Mapped Sections (what you’ll cover step-by-step)
Foundations of Claim Scrubbing
Rules & Edits Taxonomy
Building & Operating a Rule Engine
EDI & Interoperability
Provider vs Payer Perspectives
Intermediate Claim Scrubbing Topics
Advanced/Expert Rule Strategies
Operations, QA & Governance
Metrics, KPIs & Economic Impact
Integration with PMS/EHR & Up/Downstream
Compliance, Security, Ethics
Tools & Implementation Patterns
Reporting & Executive Communication
Disclosure: This course contains the use of artificial intelligence for clear voiceovers.
