Overview
Design end-to-end claim-scrubbing workflows that prevent denials before submission, Build rule engines: data validation, coding edits, sequencing, medical necessity checks, Map payer policies to edits (NCCI, LCD/NCD, bundling, frequency, age/gender, POS/TOB), Interpret EDI (837/835/277CA/999/TA1) and leverage interoperability to reduce rework, Create taxonomy of edits (hard/soft, pre-bill/post-bill) with priorities and owners, Implement HIPAA/HITECH safeguards, BAAs, audit trails, and data-protection controls, Measure impact with KPIs (first-pass rate, DSO, denial prevent %, rework cost, yield), Integrate scrubbing with PMS/EHR, clearinghouses, BI tools, and downstream finance
Medical billers/coders and AR specialists seeking pre-submission mastery, Revenue integrity, RCM analysts, and denial-prevention teams, Practice managers and compliance officers improving first-pass clean claims, Healthcare IT/interop professionals connecting PMS/EHR, clearinghouse, and BI, Quality/audit leads building edit governance, BAAs, and HIPAA/HITECH controls, Students and career-changers entering insurance/RCM automation roles
Medical Billing Fundamentals, Interest in insurance rules, coding, and revenue-cycle improvement, Willingness to follow structured QA, version control, and governance processes, No prior claim-scrubbing experience required (beginner-friendly)
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.
RCM Academy
Welcome to RCM Academy! Our founder and lead instructor has extensive experience in healthcare Revenue Cycle Management (RCM) and medical billing. With a strong background in the healthcare industry, they have trained hundreds of professionals to master the complexities of RCM processes, from patient registration to payment collection. Passionate about helping individuals succeed, the instructor designed RCM Academy to provide practical, up-to-date training on medical billing, coding, and RCM strategies. Whether you're just starting in healthcare administration or looking to expand your knowledge, RCM Academy offers the skills you need to excel in the field of medical billing and RCM.