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 key concepts of medical language and human anatomy, emphasizing the interconnectedness of body systems in health and disease. The curriculum covers topics such as the musculoskeletal, cardiovascular, respiratory, nervous, and immune systems, along with mental health and special senses, with exams at the midterm and final stages. Students with prior knowledge can optionally test out by achieving a minimum score of 80%, replacing course content if desired. It is important to understand that this course feature only applies to the online Medical Terminology course, the standalone course, or advanced career training course bundles that include Medical Terminology.
Upon completion of this course, you should be well prepared to find your place in this rewarding healthcare career. You will receive a Certificate of Completion from the school through which you enrolled, and you will also be able to take the Certified Professional Biller (CPB) exam offered by the American Academy of Professional Coders (AAPC).
This course offers enrollment with a voucher. The voucher is prepaid access to sit for the certifying exam upon eligibility. Proctor fees may apply, which are not included.
Funding Disclaimer: For Workforce Innovation and Opportunity Act (WIOA) funded students, please consult with your funding source representative before taking advantage of this course's test-out feature. Different funding programs may have specific requirements and/or restrictions. If you attempt the test-out feature(s) in the Medical Terminology course without getting approval, your funding benefits may be jeopardized.
Instructor(s):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
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.
Hide Syllabus
Lesson 1
- 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
- Introduction to Medical Billing
- Career Opportunities
- Personal and Technical Qualifications
- Employment Settings
- Telecommunications
- Professional Certifications
- Introduction to Health Insurance
- Health Insurance Terminology
- Commercial and Government Payers
- Healthcare Documentation
- Electronic Health Record
- Managed Healthcare
- Types of Reimbursement
- Managed Care Providers
- Managed Care Models
- Consumer-Directed Health Plans
- Revenue Cycle Management
- Phases of Revenue Cycle Management
- Encounter Form, Chargemaster
- Insurance Claim Cycle
- New Patient Registration
- Collection Practices
- Legal Aspects of Health Insurance and Reimbursement
- Laws Affecting Healthcare
- Protected Health Information (PHI)
- Health Insurance Portability and Accountability Act (HIPAA)
- Fraud and Abuse in Medical Billing
- Release of Information (ROI)
- ICD-10-CM Coding
- Overview of ICD-10-CM
- Key Features
- Organization of the Codebook
- Index to Diseases and Injuries
- Tabular List of Diseases and Injuries
- Coding Conventions
- Official Guidelines
- CPT Coding
- Overview of Healthcare Common Procedure Coding System (HCPCS)
- Category I, Category II, and Category III Codes
- Organization of the Codebook
- Main CPT Sections
- Evaluation and Management
- Anesthesia
- Surgery
- Radiology
- Pathology and Laboratory
- Medicine
- Code Modifiers
- HCPCS Level II Coding
- Overview of HCPCS Level II
- Organization of the Codebook
- Durable Medical Equipment
- Maximizing Reimbursement
- Price Transparency
- Data Analytics
- Billing Audits
- Pharmacology for Medical Billers
- Pharmacodynamics and Pharmacokinetics
- Routes of Administration
- Drug Classifications
- Prescription Drugs and Over-the-Counter Drugs
- Controlled Substances
- Medication Lists and the Electronic Health Record
- Midterm
- Clinical Documentation Improvement (CDI)
- Deficiencies in Documentation
- Medical Necessity
- Coding Audits
- Types of Clinical Documentation
- Insurance Claims
- National Uniform Claim Committee
- CMS-1500 Claim Form
- Patient and Insured Information
- Physician or Supplier Information
- UB-04 Claim Form
- Commercial Insurance
- Individual/Group Health Insurance, Automobile, Disability, Liability, Workers' Compensation
- Completing Commercial Health Insurance Claims
- Blue Cross Blue Shield
- History of BCBS
- Types of BCBS Plans
- Participating/Nonparticipating Providers
- BCBS Billing and Payment Guidelines
- Medicare
- Medicare Eligibility
- Medicare Part A, B, C, and D
- National Coverage Determinations/Local Coverage Determinations
- Participating/Nonparticipating Providers
- Physician Fee Schedule
- Medicare Billing and Payment Guidelines/NCCI
- Medicaid, CHIP, TRICARE, Workers' Compensation
- Medicaid
- Children's Health Insurance Program (CHIP)
- TRICARE
- Workers' Compensation
- Certification
- Importance of Certification
- Study Strategies for the Certification Exam
- Prior to the Exam
- Morning of the Exam
- During the Exam
- How to Find a Job in Medical Billing (Optional)
- Formulating Your Career Goals
- What Employers Want
- Showcasing Your Skills
- Resume Tips
- Cover Letter Tips
- Interview Questions
- FINAL
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