Building the Healthcare Brain The four steps
Medical coding fundamentals (CPT, ICD-10, HCPCS, modifiers). The claims lifecycle. Reading the 837, 835, 277CA, and EOB. HIPAA, 42 CFR 422, and CMS-0057-F.
NCCI edits, MUEs, LCDs, NCDs and how edit engines work. InterQual vs MCG criteria literacy. DRG validation. HCC coding and risk adjustment.
Clinical validation framework. Audit trails and explainability. Bias, equity, and ACA Section 1557. Building eval suites with certified-coder review.
Deep technical material per use case: Prior Auth (FHIR + Da Vinci PAS), Payment Integrity, Appeals, and Provider Denials. Pick the pod that matches what you're building.
Who should take this track
This track is designed for the people who write the code, design the prompts and models, structure the data pipelines, and own the product roadmap. That includes:
- Software engineers building claim parsers, prior auth bots, appeals generators, or denial classifiers.
- ML engineers and data scientists training models on clinical notes, claims, or coverage policies.
- Product managers who need to write specs that actually reflect how payer and provider workflows operate.
- Clinical informaticists bridging clinical workflow and engineering teams.
- Solution architects deploying AI into payer or health system environments.
Sales engineers should take the Client Engagement track instead — the depth they need is different. Builders touching customer-facing demos may benefit from both.
Prerequisites
None on the clinical side. We assume you can read JSON, understand REST APIs, and have shipped software before. Familiarity with healthcare is a bonus but not required — we start from first principles.
How to use this material
Each step page is a self-contained learning module. Read through, work the self-check questions (open the toggles only after answering in your head), and move on when you can explain the concepts back to a teammate. Module quizzes with scoring are coming — for now, treat the self-checks as diagnostic.
At Genzeon Platforms, our senior engineers and clinical PMs on Healthcare FDE pods complete the AAPC CPC certification — ~80–120 hours of study, a 100-question coding exam. We've found it produces the single largest jump in model and product quality of any external training we invest in, which is why we treat it as the bar for senior pod members rather than a nice-to-have. Step 2 covers the path. When customers buy HIP One or engage the Healthcare FDE team, the people writing their PA logic actually understand the codes they're reasoning about.