Online Training Course

Prod ID: 419
Successful Insurance Claims Processing

Learn how to expedite claims and appeals and get paid. Gain confidence that you are securing correct payments from commercial carriers and receive tips to avoid common claims processing errors.





173 min



This product is not for purchase at this time.

Up to 90% of revenue in a healthcare provider's practice flows through third-party payers. How much of it is hanging in limbo due to denials? Make sure that your dollars are flowing in the right direction. Spend less time fighting denials and more time ensuring that your front end details are in order. The window to appeal a denied claim is shrinking. Learn how to expedite claims and appeals and get paid. This program provides an overview of health insurance plans and payment models and tips on how to avoid common claims processing errors. Updated for 2023

Jan Hailey


Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program. 

Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.

Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.

This training is appropriate for health insurance claims processors with limited experience.  Medical coders, practice managers, providers, clinical staff and consultants seeking a better understanding of the overall reimbursement process may also benefit.

The content covered in this course assumes a basic understanding of insurance claims processing. No supplementary materials are required for this course.


  • Explanation and analysis of federal and commercial carrier guidelines
  • Overview of insurance plans and payment models
  • How to ensure that chart documentation supports claims submitted
  • Checklist of necessary patient information
  • Insurance verification and preauthorization
  • Working with pre-certification and authorizations for continued treatment
  • Proper use of the Advance Beneficiary Notice
  • Working with Medicare as a secondary payer
  • How to appeal inadequate reimbursements
  • Patient education and grievance issues
  • Procedure for capturing lost charges
  • Billing for pre-existing conditions
  • Coordination of benefits for covered/non-covered services
  • Working with general liability claims
  • Address common claims processing errors
  • Medicare's Correct Coding Policy as it pertains to billing
  • Tips to avoid duplicate charge rejects
  • How to handle refunds for overpayments
  • Recovery Audit contractor claim review process
  • Know your rights and responsibilities during an audit

Self-paced online program includes unlimited review of previously recorded instruction and the downloadable course materials for 6 months.

Comments from past participants:

“I think this was an excellent beginner course. There was a large amount of very good information and it was well presented.”

“The instructor was wonderful. Very insightful and the information presented was extremely helpful.”

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