Description
Certification Name: Certified Medical Claims Analyst
Global Occupational Skill Standard – GOSS ID: GOSS/HF/CMCA/V1
Eligibility: Graduation or Equivalent or minimum 2 years of relevant experience (experience-based learners can directly enroll and certify).
Objective: The Certified Medical Claims Analyst (CMCA) course aims to develop advanced expertise in reviewing, analyzing, and adjudicating medical claims with accuracy and compliance. The program trains learners to interpret medical records, understand clinical terminology, and apply standard coding systems such as ICD, CPT, and HCPCS.
Certification: Within 5 days after Completion of Online Assessment.
Get ready to join the Journey to become a GSDCI Certified Professional – International Certification and Assessment Body.
Steps to become a GSDCI Certified Professional:
Step 1: Select your certification you want to pursue.
Step 2: Click on get certified tab, new pop up window will open.
Step 3: Click on pay certification fee, you will be redirected to billing details page.
Step 4: Fill your details and click on pay certification fee, you will be redirected to payment gateway, pay fee by any available options like Card (Debit/Credit), Wallet, Paytm, Net banking, UPI and Google pay.
Step 5: You will get Login Credentials of Online E-Books and Online assessment link on your email id, within 48 hrs of payment.
Step 6: After completion of online assessment, you can download your Certificate Immediately.
Assessment Modules:
Module 1: Introduction to Medical Claims Analysis: Overview of healthcare delivery and insurance systems, Role and responsibilities of a Medical Claims Analyst, Key medical and insurance terminology, Types of healthcare claims (professional, institutional, pharmacy), Claim lifecycle and workflow overview, Importance of accuracy and compliance in claims analysis
Module 2: Medical Coding Systems and Clinical Documentation Review: ICD-10-CM diagnosis coding essentials, CPT/HCPCS procedure and supply coding basics, Use of modifiers and coding guidelines, Understanding clinical documentation and medical necessity, Identifying coding inconsistencies and documentation gaps, Common coding-related claim issues
Module 3: Claims Processing and Adjudication Procedures: Components of CMS-1500 and UB-04 claim forms, Electronic claim submission standards (EDI), Verification of patient eligibility and benefits, Payment calculation methods and coverage rules, Explanation of Benefits (EOB) and Remittance Advice (ERA) review, Timely filing requirements and correction processes
Module 4: Insurance Plans, Reimbursement Policies, and Regulatory Standards: Medicare, Medicaid, and commercial insurance policy structures, Managed care principles and payer-specific rules, DRG, APC, and fee-for-service reimbursement methodologies, Preauthorization and referral requirements, Coordination of benefits and dual coverage rules, Regulatory compliance (CMS, HIPAA, NAIC)
Module 5: Denials, Appeals, and Claims Audit Techniques: Types of denials and common root causes, Denial prevention and correction strategies, Preparing appeal letters and supporting documentation, Claims dispute processes and reconsideration steps, Internal claims audit procedures and error identification, Communication with providers and payers for issue resolution
Module 6: Advanced Claims Analysis, Reporting, and Professional Ethics: Data analysis techniques for claims trends and patterns, Identifying fraud, waste, and abuse indicators, Performance metrics and productivity reporting, Use of claims analysis software and tools, Ethical standards in claims handling and decision-making, Continuous education and professional development in claims analysis
GSDCI Online Assessment Detail:
- Duration- 60 minutes.
- Number of Questions- 30.
- Number of Questions from each module: 5.
- Language: English.
- Exam Type: Multiple Choice Questions.
- Maximum Marks- 100, Passing Marks- 50%.
- There is no negative marking in any module.
| Marking System: | |||
| S.No. | No. of Questions | Marks Each Question | Total Marks |
| 1 | 10 | 5 | 50 |
| 2 | 5 | 4 | 20 |
| 3 | 5 | 3 | 15 |
| 4 | 5 | 2 | 10 |
| 5 | 5 | 1 | 5 |
| 30 | 100 | ||
| How Students will be Graded: | |||
| S.No. | Marks | Grade | |
| 1 | 91-100 | O (Outstanding) | |
| 2 | 81-90 | A+ (Excellent) | |
| 3 | 71-80 | A (Very Good) | |
| 4 | 61-70 | B (Good) | |
| 5 | 50-60 | P (Pass) | |
| 6 | 0-49 | F (Fail) | |
Benefits of Certification:
🌍 1. Global Recognition & Credibility – Stand out worldwide with a certification that opens doors across borders. Trusted by employers, respected by institutions, and recognized in over 100 countries.
📜 2. Quality Assurance through ISO Certification – Certified to global ISO standards, our programs deliver excellence, consistency, and a benchmarked learning experience that speaks for itself.
💼 3. Career Advancement & Employability – Enhances your resume and increases chances of promotions or job offers.
🤝 4. Non-Profit Trust Factor – Certifications from non-profit organizations are mission-driven rather than profit-driven.
📚 5. Access to Verified Learning & Resources – Often includes e-books, mock tests, and online support without hidden costs.
🔍 6. Transparency & Online Verification – Certifications come with a unique Enrolment ID for easy online verification by employers and institutions.
⏳ 7. Lifetime or Long-Term Validity – Certifications usually have lifetime validity or long-term recognition, reducing the need for frequent renewals.
