Global Certificate in Claim Processing Efficiency
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โข Claim Processing Foundation: Introduction to Claim Processing, Key Stakeholders in Claim Processing, Types of Claims, Understanding Healthcare and Insurance Terminologies
โข Claim Forms and Codes: Overview of Claim Forms, CPT, HCPCS, ICD and Other Coding Systems, Reading and Interpreting Insurance Cards
โข Electronic Data Interchange (EDI): Introduction to EDI, Benefits and Challenges, HIPAA EDI Standards, Implementing EDI in Claim Processing
โข Claim Processing Workflow: Pre-authorization and Referrals, Collecting and Verifying Patient Information, Submitting Claims, Handling Rejections and Denials, Appeals and Grievances
โข Legal and Ethical Considerations: Compliance with Federal and State Regulations, Understanding HIPAA, False Claims Act, and Stark Laws, Maintaining Patient Confidentiality, Ethical Decision Making in Claim Processing
โข Performance Measurement and Improvement: Metrics for Claim Processing Efficiency, Identifying Bottlenecks and Errors, Improving Claim Processing Workflow, Implementing Continuous Improvement Practices
โข Technology in Claim Processing: Overview of Claim Processing Software, Robotic Process Automation (RPA), Artificial Intelligence (AI) and Machine Learning (ML) in Claim Processing, Cybersecurity and Data Protection
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