RCM Benefits, Referrals & Prior Authorizations for Beginners

Are you looking to build a solid foundation in referrals, prior authorizations, and benefits verification?

This course is your comprehensive guide to understanding these essential administrative functions in healthcare — even if you're starting from scratch.

In this beginner-friendly course, you'll:

• Learn the fundamentals of referrals: Understand what referrals are, when they're needed, and how to initiate and manage the referral process from start to finish.

• Master the authorization workflow: Get a clear, step-by-step guide on how to request prior authorizations, submit required documents, and follow up effectively with insurance companies.

• Verify patient eligibility and benefits: Learn how to check insurance coverage, interpret plan types (HMO, PPO, Medicare, Medicaid), and identify when referrals or authorizations are required.

• Set up productivity metrics: Understand how to define KPIs (Key Performance Indicators) and SLAs (Service Level Agreements) to measure performance and improve workflow efficiency.

• Get familiar with tools and systems: Explore how Practice Management Systems (PMS), Electronic Health Records (EHR), and payer portals are used to streamline front-end processes.

• Handle denials and follow-ups: Learn how to respond to referral or authorization denials, gather supporting documents, and submit appeals when needed.

By the end of this course, you'll have the knowledge and confidence to manage referrals, prior authorizations, and benefits verification effectively — all while tracking performance and contributing to operational excellence in any healthcare setting.