Program Overview
About This Program
Become a Professional Medical Biller and Coder in the Healthcare Sector. Process insurance claims and assist providers with coding diagnosis and patient services.
At AlliedRx Institute of Healthcare, we offer a robust curriculum that covers all aspects of medical billing and coding. You will gain a deep understanding of medical terminology, procedure codes, and the intricacies of the healthcare industry. Our courses also introduce you to the Common Procedure Coding System (HCPCS), an essential tool used in accurately assigning procedure codes for medical services.
Upon completion of our training program, you will be fully prepared to take the AAPC, NHA or AHIMA designated exams. These comprehensive exams evaluate your knowledge and skills in medical coding, including accurately assigning procedure codes, understanding medical histories, and navigating the healthcare common procedure coding system.
The demand for skilled medical billers and coders is on the rise, making it an excellent career choice with opportunities across hospitals, clinics, insurance companies, and physician practices nationwide.
Learning Objectives
What You Will Learn
By the end of this program, students will have mastered the core competencies required to work as a professional Medical Billing & Coding Specialist.
Develop a foundational understanding of medical terminology, anatomy, and physiology to accurately interpret medical records and documentation.
Learn to navigate the International Classification of Diseases (ICD-10-CM) system and assign accurate diagnosis codes based on clinical documentation.
Apply Current Procedural Terminology (CPT) and HCPCS Level II codes to accurately represent medical services, procedures, and supplies for billing.
Understand HMOs, PPOs, Medicare, Medicaid, and the claims submission process to ensure providers receive appropriate reimbursement for services.
Apply HIPAA regulations to protect patient privacy and maintain ethical, accurate billing practices that comply with federal and state standards.
Navigate electronic health record systems to extract clinical documentation, support coding accuracy, and facilitate seamless billing workflows.
Submit clean paper and electronic claims, identify common denial reasons, and execute effective appeals and resolution strategies.
Prepare for the NHA CBCS, AAPC CPC, and AHIMA CCS board examinations using interactive study guides and timed practice assessments.
Course Schedule
14-Week Program Outline
The program is divided into three phases, progressing from foundational insurance and coding knowledge to advanced billing operations and board exam readiness.
| Week | Topic / Module | Key Learning Areas |
|---|---|---|
| Week 1 | Fundamentals of Health Insurance | History of US healthcare, HMOs, PPOs, POS plans, individual & group insurance, Medicare & Medicaid overview |
| Week 2 | Medical Terminology & Anatomy | Body systems, medical prefixes/suffixes, directional terms, organ structure applied to coding |
| Week 3 | Electronic Health Records | EHR navigation, clinical documentation, patient chart components, release of information |
| Week 4 | Compliance, Privacy & Ethics | HIPAA regulations, fraud and abuse in billing, PHI protection, ethical coding standards |
| Week | Topic / Module | Key Learning Areas |
|---|---|---|
| Week 5 | ICD-10-CM Diagnosis Coding | ICD-10-CM structure, code lookup, code sequencing guidelines, diagnosis coding conventions |
| Week 6 | CPT Procedure Coding | CPT code structure, Evaluation & Management (E&M) codes, surgical coding, modifiers |
| Week 7 | HCPCS Level II Coding | HCPCS codes for supplies, DME, drugs, ambulance services, Medicare-specific billing |
| Week 8 | Medicare & Medicaid Billing | Medicare Parts A–D, Medicaid eligibility, coverage rules, claim submission requirements |
| Week 9 | Blue Plans & Private Insurance | Blue Cross Blue Shield plans, commercial payer policies, coordination of benefits, prior authorization |
| Week 10 | TRICARE, CHAMPVA & Workers Comp | Military insurance programs, veterans benefits, workers compensation billing procedures |
| Week | Topic / Module | Key Learning Areas |
|---|---|---|
| Week 11 | Paper & Electronic Claims | CMS-1500 form completion, EDI 837 electronic claims, clearinghouses, claim submission workflow |
| Week 12 | Hospital Billing & Receiving Payments | UB-04 forms, inpatient vs. outpatient billing, remittance advice, payment posting, reconciliation |
| Week 13 | Denial Management & Appeals | Common denial codes, root cause analysis, appeals process, resubmission strategies, AR follow-up |
| Week 14 | Comprehensive Review & Exam Prep | NHA CBCS, AAPC CPC & AHIMA CCS exam strategies, timed practice tests, final knowledge evaluation |
Assessment & Grading
Grading Policy
Student progress is measured through module assessments, coding simulations, claim-processing exercises, and a final comprehensive exam.
| Assessment Component | Weight |
|---|---|
| Module Knowledge Assessments (x12) | 30% |
| Coding Simulations & Exercises | 20% |
| Midterm Exam (Week 7) | 15% |
| Claim Processing Evaluations | 15% |
| Board Exam Practice Assessments | 10% |
| Final Comprehensive Exam (Week 14) | 10% |
Retake Policy: Students may retake module assessments up to 2 times. The highest score will be recorded.