Overview
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Competent, well-trained medical billers are vital to the financial success of the professional healthcare services claims process. With increasing reimbursement pressures in the healthcare industry, there is a growing need for organizations to hire highly trained and skilled medical billers. As a result, professionals with an understanding of medical insurance, reimbursement methodologies, and the claims process are currently in high demand.
As a CPB-certified professional, you will enter the job market with proven abilities to submit claims compliant with respect to government regulations and private payer policies.
To earn a CPB certification, you must pass the CPB exam, a test of medical billing proficiency with questions that assess your understanding of the types of insurance plans, local and national coverage determinations, and more. The Certified Professional Biller (CPB) credential validates your ability to maintain various aspects of the revenue cycle with specific focus on patient and payer billing and collections. You will be fully trained — not just to pass the certification exam, but with the training and expertise needed to thrive on the job from day one.
In order to successfully complete the Coding and Medical Necessity course in the program, learners will need the CPT, ICD-10-CM, and the HCPCS Level II code books. These can be purchased on the AAPC website.
Syllabus
- Course 1: Introduction to Certified Professional Biller
- Course 2: Coding and Medical Necessity
- Course 3: The Billing and Collection Process
- Course 4: Insurance Specifics
Courses
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This course provides a foundational understanding of medical coding systems and the essential role of medical necessity in healthcare documentation and reimbursement. Students will explore the basics of ICD-10-CM, CPT, and HCPCS Level II coding and learn to navigate code sets accurately. The course also addresses how medical necessity affects claim approvals, compliance, and revenue cycle performance. Through real-world examples and hands-on practice, students will develop the skills needed to assign accurate codes and apply payer-specific medical necessity policies to support successful claim submission.
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This course offers an in-depth overview of major insurance carriers that impact medical billing and reimbursement, including Medicare, Medicaid, TRICARE, Blue Cross/Blue Shield, commercial plans, and workers’ compensation. Students will explore the unique coverage policies, billing guidelines, and reimbursement methods associated with each payer type. The course also covers best practices for claim submission, prior authorization, and compliance with payer-specific requirements. By the end, students will understand how to reduce denials and support accurate, timely reimbursement across various insurance programs.
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This course introduces the U.S. healthcare system and emphasizes the critical role of medical billing in the reimbursement process. Students will examine key insurance models, including private, government, and managed care plans, and how each impacts billing procedures. The course also covers core administrative processes such as patient registration, accurate data collection, and eligibility verification. Through practical examples, students will gain a foundational understanding of how accurate front-end processes support clean claims, timely reimbursement, and overall revenue cycle success.
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This course provides a comprehensive introduction to key components of medical billing, claim forms, and accounts receivable (A/R) management. Students will learn how to accurately complete and submit CMS-1500 and UB-04 claim forms, understand billing workflows, and apply effective strategies for managing A/R and collections. Topics include claim adjudication, denial management, and compliance with healthcare regulations. Through real-world scenarios and hands-on activities, students will develop practical skills to support timely reimbursement, reduce errors, and improve overall revenue cycle performance.
Taught by
Katherine Abel