Healthcare Revenue Cycle and Claims Fundamentals
How a clinical encounter becomes a paid claim — and why it so often does not.
Program overview
The revenue cycle is where clinical work meets money, and errors anywhere in it are expensive. This course follows the cycle end to end: eligibility and pre-authorisation, charge capture, coding at a conceptual level, claim submission and edits, remittance and payment posting, denial classification and appeal, and the metrics that reveal where a cycle is losing money. It is deliberately payer-agnostic and covers both provider-side and payer-side operations, which most training ignores entirely.
Why this program
Follows the full cycle end to end
Payer-agnostic and internationally applicable
Covers denial management and appeal properly
Includes payer-side operations, usually omitted
Who it is for
Program objectives
- Describe the stages of the revenue cycle and their dependencies
- Explain eligibility verification and pre-authorisation requirements
- Describe charge capture and the causes of revenue leakage
- Explain the role of coding within the claim process
- Classify denials and construct an appropriate appeal
- Interpret the principal revenue cycle performance metrics
Learning outcomes
- Sequence the stages of the revenue cycle for a described encounter
- Identify the cause of a described claim rejection
- Classify a described denial and select an appropriate response
- Calculate and interpret a revenue cycle metric from given data
- Identify a charge capture failure in a described process
- Evaluate a pre-authorisation process for risk
Curriculum
Module 1: The Cycle End to End
1 lessonsThe Cycle End to EndPreview
From scheduling to zero balance, and who owns each step.
Module 2: Front End: Eligibility and Authorisation
1 lessons- Front End: Eligibility and Authorisation
Module 3: Charge Capture and Coding
1 lessons- Charge Capture and Coding
Module 4: Submission, Edits and Remittance
1 lessons- Submission, Edits and Remittance
Module 5: Denials and Appeals
1 lessons- Denials and Appeals
Module 6: Measuring the Cycle
1 lessons- Measuring the Cycle
Duration and structure
6 lessons across 6 modules. Duration is expressed in study hours.
What you receive
This certificate confirms completion of Healthcare Revenue Cycle and Claims Fundamentals. Duration is expressed in study hours.
Delivery format
- Self-paced — start any time.
- Study on any device.
- Lifetime access to the version you enrolled in.