Healthcare Revenue Cycle and Claims Fundamentals

1. 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.

2. 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.

3. Who it is for

Healthcare Manager · Medical Secretary · Quality Officer · Allied Health

4. 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

5. 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

6. Curriculum

1. Module 1: The Cycle End to End

   • The Cycle End to End

2. Module 2: Front End: Eligibility and Authorisation

   • Front End: Eligibility and Authorisation

3. Module 3: Charge Capture and Coding

   • Charge Capture and Coding

4. Module 4: Submission, Edits and Remittance

   • Submission, Edits and Remittance

5. Module 5: Denials and Appeals

   • Denials and Appeals

6. Module 6: Measuring the Cycle

   • Measuring the Cycle

7. Duration and structure

Total study hours: 4 — 3.25h content + 0.75h assessment. Duration is expressed in study hours only.

9. What you receive

This certificate confirms completion of Healthcare Revenue Cycle and Claims Fundamentals. Duration is expressed in study hours.

10. Delivery format

Self-paced · start any time · any device · lifetime access to the enrolled version.