Overview
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.
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
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.
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:
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 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.
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.