Master claim scrubbing, edits & rule engines for medical billing RCM, HIPAA/HITECH, BAA, protection, EDI, compliance IT!
Sub Category
- Operations
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Objectives
- 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
Pre Requisites
- 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)
FAQ
- Q. How long do I have access to the course materials?
- A. You can view and review the lecture materials indefinitely, like an on-demand channel.
- Q. Can I take my courses with me wherever I go?
- A. Definitely! If you have an internet connection, courses on Udemy are available on any device at any time. If you don't have an internet connection, some instructors also let their students download course lectures. That's up to the instructor though, so make sure you get on their good side!
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