This program equips healthcare and operations leaders to deploy AI, Generative AI, and RPA across administration, clinical support, and patient experience. Participants learn practical blueprints for automating revenue cycle workflows, orchestrating agentic assistants such as “Amber”-style digital copilots, and scaling human-in-the-loop AI that elevates quality, speed, and compliance.
Security is treated as a design constraint, not an afterthought: you’ll apply governance, access controls, and auditability to every AI touchpoint. Expect clear guidance on protecting PHI, aligning with HIPAA, and hardening data flows against model leakage, prompt injection, and vendor risks. These cybersecurity practices ensure resilient, trustworthy AI operations that sustain clinical and business outcomes.
Learning Objectives:
- Automate revenue cycle and claims processes with measurable KPIs.
- Apply NLP for documentation, coding, and payer/provider correspondence.
- Integrate human-in-the-loop AI into frontline and back-office workflows.
- Implement agentic AI patterns in clinical and administrative domains.
- Ensure end-to-end governance, privacy, and cybersecurity in AI deployments.
Audience:
- Healthcare Administrators
- Clinical Operations Leaders
- Health IT & Informatics Managers
- Data/AI Engineers & Analysts
- RCM and Billing Managers
- Compliance & Risk Officers
- Cybersecurity Professionals
Program Modules:
Module 1: Healthcare Administration AI
- Prioritization of back-office use cases
- Eligibility, benefits, and prior-auth automation
- Claims status, denials, and appeals orchestration
- Scheduling, referrals, and contact-center routing
- PHI-safe data pipelines and observability
- ROI modeling and value realization
Module 2: GenAI for Clinicians
- Summarization for notes and handoffs
- Clinical question-answering with guardrails
- Drafting orders and patient instructions
- Evidence retrieval and model citations
- Bias, safety, and escalation pathways
- Outcome tracking and feedback loops
Module 3: RPA for RCM
- Bot design for charge capture tasks
- ERA/EOB posting and reconciliation
- Denial pattern detection and auto-work
- Clearinghouse and payer integrations
- Exception queues and human reviews
- Monitoring, SLAs, and failover plans
Module 4: Human-AI Collaboration
- Task decomposition and role design
- Human override, approvals, and sign-offs
- Explainability in high-stakes steps
- Playbooks for exception handling
- Training, upskilling, and adoption
- Metrics: accuracy, latency, equity
Module 5: Agentic System Design
- Tool use, memory, and multi-agent flows
- Event-driven orchestration and routing
- Policy as code, prompts as products
- Audit trails and secure action execution
- Vendor, EHR, and platform interoperability
- Cost control and capacity planning
Module 6: Patient Experience Analytics
- Intake, triage, and digital front door
- Personalized navigation and reminders
- Sentiment/NLP on messages and calls
- Accessibility and multilingual support
- Privacy-preserving analytics at scale
- Measuring CES, NPS, and outcomes
Exam Domains:
- Operational AI Strategy
- Clinical Decision Support Governance
- Revenue Cycle Automation Controls
- NLP & Document Intelligence
- Human-in-the-Loop Assurance
- Ecosystem & Platform Integration
Course Delivery:
The course is delivered through a combination of lectures, interactive discussions, workshops, and project-based learning facilitated by experts in healthcare AI. Participants gain access to curated online resources, case studies, templates, and tooling guidance for practical takeaways.
Assessment and Certification:
Participants are assessed via quizzes, assignments, and a capstone project. Upon successful completion, learners receive a certificate in Certified AI in Healthcare Operations (CAIHO).
Question Types:
- Multiple Choice Questions (MCQs)
- Scenario-based Questions
Passing Criteria:
To pass the Certified AI in Healthcare Operations (CAIHO) Certification Training exam, candidates must achieve a score of 70% or higher.
Ready to modernize healthcare operations with safe, scalable AI? Enroll in CAIHO by Tonex and accelerate your transformation.