Medical Billing Specialist (Voucher Included)

The Medical Billing Specialist course offers valuable training in legal, ethical, and regulatory concepts that are central to this field, including HIPAA compliance, fraud and abuse in medical billing, and third-party payer guidelines. You will also understand all phases of the revenue cycle, including patient registration, charge capture, medical coding, claim submission, data analytics, payer reimbursement, patient billing, and collection practices.

The medical terminology course introduces...

12 Months / 310 Course Hrs

Open Enrollment

Offered in partnership with your preferred school

Clark State College

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Learning method

Instructor-led

$2,495

Self-paced. Study on your own schedule

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Details + Objectives

Course code: GES1019

What you will learn

Describe the different stages of the revenue cycle
Recognize federal laws that affect healthcare
Define health insurance and medical terminology
Use the ICD-10-CM, CPT, and HCPCS Level II codebooks to assign medical codes accurately
Explain the data entry requirements of a medical insurance claim form
Identify the billing guidelines of government and private payers
Recount the structures, functions, and disorders of the different body systems

How you will benefit

Be able to manage the revenue cycle to maximize reimbursement effectively
Recognize fraud and abuse in medical billing
Assign medical codes from different types of clinical documentation
Complete medical claims according to payer guidelines
Access to the Land the Job resource to assist in taking your job preparation to the next level
Gain confidence in your exam-taking abilities through repeated practice with the mock exam, ensuring you are well-prepared to pass the certification exam
Receive a Certificate of Completion that will show a prospective employer that you received comprehensive, up-to-date training in medical billing that may set you apart from other candidates
Receive a voucher for the Certified Professional Biller (CPB) exam offered by the American Academy of Professional Coders (AAPC) that will bolster your resume and authenticate your skillset

How the course is taught

Self-paced, online course
12 Months to complete
Open enrollment, begin anytime
310 course hours

Outline

Medical Terminology

Getting Started
How to Take This Course
Test-Out Exam 1: Lessons 1–Midterm Exam
Introduction to Medical Terminology and the Human Body in Health and Disease
The Musculoskeletal System
The Cardiovascular System
The Lymphatic and Immune Systems
The Respiratory System
The Digestive System
The Urinary System
Midterm
Test-Out Exam 2: Lessons 8–Final Exam
The Nervous System
Special Senses: The Eyes and Ears
The Integumentary System
The Endocrine System
Mental Health
Male and Female Reproductive Systems
Diagnostic Procedures, Nuclear Medicine, and Complementary Medicine
Final Exam

Medical Billing Specialist
1. Introduction to Medical Billing
  1. Career Opportunities
  2. Personal and Technical Qualifications
  3. Employment Settings
  4. Telecommunications
  5. Professional Certifications
2. Introduction to Health Insurance
  1. Health Insurance Terminology
  2. Commercial and Government Payers
  3. Healthcare Documentation
  4. Electronic Health Record
3. Managed Healthcare
  1. Types of Reimbursement
  2. Managed Care Providers
  3. Managed Care Models
  4. Consumer-Directed Health Plans
4. Revenue Cycle Management
  1. Phases of Revenue Cycle Management
  2. Encounter Form, Chargemaster
  3. Insurance Claim Cycle
  4. New Patient Registration
  5. Collection Practices
5. Legal Aspects of Health Insurance and Reimbursement
  1. Laws Affecting Healthcare
  2. Protected Health Information (PHI)
  3. Health Insurance Portability and Accountability Act (HIPAA)
  4. Fraud and Abuse in Medical Billing
  5. Release of Information (ROI)
6. ICD-10-CM Coding
  1. Overview of ICD-10-CM
  2. Key Features
  3. Organization of the Codebook
  4. Index to Diseases and Injuries
  5. Tabular List of Diseases and Injuries
  6. Coding Conventions
  7. Official Guidelines
7. CPT Coding
  1. Overview of Healthcare Common Procedure Coding System (HCPCS)
  2. Category I, Category II, and Category III Codes
  3. Organization of the Codebook
  4. Main CPT Sections
  5. Evaluation and Management
  6. Anesthesia
  7. Surgery
  8. Radiology
  9. Pathology and Laboratory
  10. Medicine
  11. Code Modifiers
8. HCPCS Level II Coding
  1. Overview of HCPCS Level II
  2. Organization of the Codebook
  3. Durable Medical Equipment
9. Maximizing Reimbursement
  1. Price Transparency
  2. Data Analytics
  3. Billing Audits
10. Pharmacology for Medical Billers
  1. Pharmacodynamics and Pharmacokinetics
  2. Routes of Administration
  3. Drug Classifications
  4. Prescription Drugs and Over-the-Counter Drugs
  5. Controlled Substances
  6. Medication Lists and the Electronic Health Record
11. Midterm
12. Clinical Documentation Improvement (CDI)
  1. Deficiencies in Documentation
  2. Medical Necessity
  3. Coding Audits
  4. Types of Clinical Documentation
13. Insurance Claims
  1. National Uniform Claim Committee
  2. CMS-1500 Claim Form
  3. Patient and Insured Information
  4. Physician or Supplier Information
  5. UB-04 Claim Form
14. Commercial Insurance
  1. Individual/Group Health Insurance, Automobile, Disability, Liability, Workers' Compensation
  2. Completing Commercial Health Insurance Claims
15. Blue Cross Blue Shield
  1. History of BCBS
  2. Types of BCBS Plans
  3. Participating/Nonparticipating Providers
  4. BCBS Billing and Payment Guidelines
16. Medicare
  1. Medicare Eligibility
  2. Medicare Part A, B, C, and D
  3. National Coverage Determinations/Local Coverage Determinations
  4. Participating/Nonparticipating Providers
  5. Physician Fee Schedule
  6. Medicare Billing and Payment Guidelines/NCCI
17. Medicaid, CHIP, TRICARE, Workers' Compensation
  1. Medicaid
  2. Children's Health Insurance Program (CHIP)
  3. TRICARE
  4. Workers' Compensation
18. Certification
  1. Importance of Certification
  2. Study Strategies for the Certification Exam
  3. Prior to the Exam
  4. Morning of the Exam
  5. During the Exam
19. How to Find a Job in Medical Billing (Optional)
  1. Formulating Your Career Goals
  2. What Employers Want
  3. Showcasing Your Skills
  4. Resume Tips
  5. Cover Letter Tips
  6. Interview Questions
20. FINAL

Instructors & Support

Nancy Smith

Nancy Smith has over 30 years of experience in the healthcare industry. Her clinical experience includes working as a medical assistant for a network of rural health clinics, and as a medical coder, insurance claims specialist, and medical records auditor. She worked as a medical office manager for ten years, where she recruited and trained all medical assistants. Nancy holds a bachelor's degree in vocational education and has developed and taught medical assistant programs.

LaTisha Cottingham

LaTisha Cottingham has over 20 years of experience in the healthcare industry. She has six years of teaching experience in the field of medical billing and coding and Medical Assisting. Currently, she is employed as an HIM Analyst for a Long-Term Care establishment that is based out of Alabama. Previously she was employed as the lead instructor for the Allied Health Department for a local career institute. LaTisha's field of expertise is in the area of physician-based inpatient coding and Emergency Department coding. The certifications that she holds are as follows: a Registered Health Information Technician (RHIT), a Certified Professional Coder (CPC), and a Certified Clinical Medical Assistant (CCMA). In preparation for ICD-10-CM, LaTisha received her ICD-10-CM/PCS Trainer Certification from American Health Information Association (AHIMA), where she is currently a member. LaTisha is also a member of the American Academy of Professional Coders (AAPC) and the National Healthcare Association (NHA) where she is a test proctor.

Carline Dalgleish

Carline Dalgleish has worked in medical office administration for over 30 years. She holds a bachelor's degree in Business Information Systems, a master's degree in Leadership, and a post-baccalaureate certificate in Health Information Management. She is a Registered Health Information Administrator and an AHIMA Approved ICD-10-CM/PCS Trainer. Dalgleish is the author of an ICD-10 coding system and owns her own consulting firm, AnnGrant Educational Services.

Lydia S. Stewart

Lydia S. Stewart, RN, BSN, currently serves as the Revenue Cycle Manager at a large regional medical center. Lydia has been a Registered Nurse for 23 years, 15 of those years specializing in Critical Care Nursing and supervision. She is responsible for Medical Audits, Charge Capture, and governmental compliance audits and reviews. Lydia is a member of the Louisiana Medical Auditor Association and Healthcare Financial Management Association (HFMA).

Bunny Reeves

Bunny Reeves is the senior ambulatory surgery coder at the Maimonides Medical Center in Brooklyn, New York. She trains student coders at Maimonides Medical Center and previously trained and supervised entry-level coders at Staten Island's St. Vincent Medical Center. Reeves is a Certified Coding Specialist, accredited by the American Health Information Management Association (AHIMA).

Sharon L. Blackford

Sharon L. Blackford, MA, BA, RMA, has over 30 years of experience in the medical field. She has a Master's degree in Organizational Management, a Bachelor's degree in Business Management, and has served as a Registered Medical Assistant since 1994. Sharon was an active duty Clinical Specialist in the U.S. Army for 10 years. Sharon later moved to the Gulf Coast to accept a position as the Director of Education of Blue Cliff College and was promoted to Campus Director.

Stacey O'Brien

Stacey O'Brien has more than 10 years of experience in medical coding and reimbursement. Ms. O'Brien has been a risk adjustment coder for a Medicare advantage plan, audited medical records for a consulting firm, and currently supervises the coding and electronic claims submission process for a group medical practice. She has a bachelor's degree from the University of Pittsburgh and a CPC coding certification from the AAPC.

April Adams

April Adams, M.S., RHIA, CDIP, CPC-I, CPB, CPMA, has worked in the healthcare field since 2011, transitioning from a high school biology and chemistry teacher to a specialist in medical coding and auditing. She focuses on HCC, clinical documentation improvement (CDI), and DRGs and has taught health information management (HIM) courses, including medical terminology, law and ethics, coding, and revenue cycle management since 2018.

April possesses a master's in health information management with a specialization in data analytics.. She also serves on the board of the Dallas-Fort Worth Health Information Management Association and holds multiple industry certifications.

Medical Terminology Instructors

Our medical terminology course section is taught by multiple experienced instructors. See here for a full list of these instructors.

Instructor Interaction: The instructor looks forward to interacting with learners in the online moderated discussion area to share their expertise and answer any questions you may have on the course content.

Requirements

Prerequisites:

There are no prerequisites to take this course.

Certification Requirements:

To sit for national certification exams, candidates must have a high school diploma or equivalent. Therefore, it is recommended you have this before enrolling for this course. Certification exams offered by AAPC are only available online to candidates located in the US.

Requirements:

Hardware Requirements:

This course can be taken on a PC or Mac.

Software Requirements:

PC: Windows 8 or later.
Mac: macOS 10.6 or later.
Browser: The latest version of Google Chrome or Mozilla Firefox is preferred. Microsoft Edge and Safari are also compatible.
Microsoft Word or an equivalent word-processing program.
Adobe Acrobat Reader.
Software must be installed and fully operational before the course begins.

Other:

Email capabilities and access to a personal email account.

Instructional Material Requirements:

The instructional materials required for this course are included in enrollment.

The following digital textbook for the Medical Terminology course is accessed via links in the course lessons:

Comprehensive Medical Terminology for Health Professions, 1st Edition (eBook)

The following digital textbooks for Medical Billing Specialist are accessed via links in the lessons:

Understanding Health Insurance: A Guide to Billing and Reimbursement (eBook)
Accompanying Workbook: Understanding Health Insurance: A Guide to Billing and Reimbursement (eBook)

The following textbooks will be shipped to you approximately 7-10 business days after enrollment in Medical Billing Specialist:

ICD-10-CM Expert for Physicians
CPT Professional
HCPCS Level II Professional

Shipped upon completion:

CPB Certification Study Guide, from AAPC

Please note: You will receive a digital book if the physical book is on backorder.

*The course includes the current year of coding books, and you will be responsible for purchasing your updated coding books from year to year.

More About

About Certification: American Academy of Professional Coders (AAPC)

The American Academy of Professional Coders (AAPC) is one of the world's most recognized institutions for professional medical coders, with more than 175,000 members. The AAPC offers more than 30 certifications that include medical billing and coding, compliance, and management, among other topics. These certifications are an excellent way to prove you have a working knowledge of specific aspects of healthcare, and the skills you need to practice in the field. All AAPC certifications share a common goal: help everyone from beginners to experienced professionals advance their careers and contribute positively to the industry.

FAQ

Medical billing is the process of submitting health insurance claims on behalf of a patient to various health insurance payers to acquire payment for services provided by a medical facility.

According to the Bureau of Labor Statistics, the job outlook for medical billers will increase 8% between 2020-2026 – a growth rate higher than average.

AAPC reports (in 2022) the median pay for a medical biller with a CPB (Certified Professional Biller) credential was $56,981.

Medical billers follow strict processes to ensure that payment requests are submitted the correct way to receive payment promptly. Without the knowledge of these processes, healthcare provider reimbursement may be compromised.

Medical billing training and certification are important because they not only help you gain the knowledge you need for success in the profession, but they also provide ways for you to prove to employers that you have the skills needed to perform the job. Industry certifications can help your resume stand out from other job applicants and could make the difference in you getting an interview and ultimately a job. According to the AAPC, Certified Professional Biller (CPB™) certification "demonstrates a professional's working knowledge to support cleaner claim submission, faster reimbursement, fewer denials, and better run practices and facilities."

Medical billing and coding are separate processes, but both are important regarding receiving payment for healthcare services. Medical billers are mainly responsible for submitting patient records to government agencies and insurance companies for services that have been provided in the care of the patient. Medical coders gather information on patient records and assign the proper codes for patient diagnosis, which are then used by medical billers to submit claim forms.

This course provides a comprehensive approach to career training and certification preparation. We offer scenario-based learning with frequent interactivities and safe-to-fail exercises to help you practice the skills you obtain. Our course provides hands-on practice with claims and coding with work assignments that help learners apply concepts presented in this course. The CPB™ certification exam and prep assets are included within the cost of tuition.

Yes, this program prepares you for the Certified Professional Billing (CPB™) exam offered by the American Association of Professional Coders. Complete this course 100% online at your own pace and utilize the certification prep assets, which will get you ready to sit for and successfully pass your CPB™ exam. You will receive a voucher for the exam after successfully completing the program and your financial obligation.

A practicing or aspiring medical biller can prepare for and take a national certification exam, such as the Certified Professional Biller (CPB™) offered by the American Association of Professional Coders (AAPC) and included in this course. Successfully passing this exam will provide you with the CPB™ designation.

The American Association of Professional Coders (AAPC) is an organization founded in 1988 to provide education and certification for professional medical billers and coders. It also exists to heighten the standards of the industry through training, certification, networking, and job opportunities. The AAPC has over 200,000 members globally and offers 28 different certifications related to the business side of healthcare.

You will have up to 12 months to complete this online, self-paced course, but depending on your time commitment and study schedule, you may be able to complete the course much sooner. Upon successful completion of this course, we encourage you to take advantage of the included certification prep materials and then register to take the CPB™ exam.

The cost of the CPB™ certification exam will be included in the cost of enrollment. You will receive a voucher at the end of your course that you can use to sit for the exam when you're ready. There is no additional cost.

Yes, you will be prepared for the Certified Professional Biller (CPB) exam offered by the American Academy of Professional Coders (AAPC). Upon successful completion of the course, you will receive a certification exam voucher and applicable study materials to prepare for the exam. Certification exams through AAPC and NHA are only offered online to candidates located in the US.

Yes. This course includes two, optional, Test-Out Exam features that will allow you to test out of content and graded assessments if your score demonstrates the level of mastery required (80%). It does not count toward your overall score in this course if you do not achieve the minimum score required for mastery. Please note: Third party funded students may not be eligible.

This course is open enrollment, so you can register and start the course whenever you are ready. Access to your course can take 24-48 business hours.

After you register, you will receive 12 months to complete the course. The time allotted for completion has been calculated based on the number of course hours.

If you are unable to complete the course, contact your Student Advisor to help you work out a suitable completion date. Please note that an extension fee will be charged. If you are funded through a third-party organization, approval may also be required.

Our courses are designed to accommodate various learning preferences. Depending on the course structure, you may get different forms of support. Self-paced courses are designed to be user-friendly and independent, minimizing the need for external support. In courses with instructors, our direct platform support feature includes opportunities for questions, discussions, and remediation, with email and phone support available for select courses. Our student advising team is available to guide you on program requirements and administrative requests, but they do not provide assistance with course content. Our goal is to provide you with the necessary support for success, whether it's through self-paced exploration, direct communication, or guidance from our advising team.

Upon successfully passing the final exam, you will be awarded a certificate of completion from the school or organization that you registered through. You will also receive a certification exam voucher and applicable study materials for the Certified Professional Biller (CPB) exam offered by the American Academy of Professional Coders (AAPC).

ed2go courses will help you gain the skills you need to obtain an entry-level position in most cases. However, you should always research the job market in your area before enrolling. You may also receive assistance from our Clinical Experience Coordinator and access to a Clinical Experience Guide included in your course.

ed2go courses are non-credit, so they do not qualify for federal aid, FAFSA, and Pell Grant. In some states, vocational rehab or workforce development boards may provide funding to take our courses. Additionally, you may qualify for financial assistance if you meet certain requirements. Learn more about financial assistance.

If you have questions that are not answered on our website, representatives are available via LIVE chat. You can also call us at 1-877-221-5151 during regular business hours to have your questions promptly answered. If you are visiting us during non-business hours, please send us a question using the "Contact Us."

Medical Billing Specialist (Voucher Included)

Clark State College