FREQUENTLY ASKED QUESTIONS
Welcome to the FAQs section for the Managed Health Care Certification program. This area is provided to you as a source of information that may be more clarified, related to questions you may have in regards to our certification program. Information regarding recertification, as well as information about our online continuing education courses, is also provided. We highly recommend that you first thoroughly review all of the information on our website, under the main page for Managed Health Care Certification. Access main page.
If after reviewing all of the provided information and this FAQs section, any other questions may be addressed by completing our request for information form online here. Thank you for your interest in our Managed Health Care certification and education program.
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What is Certification?
Answer: Certification is a voluntary process provided by via an organization that through its qualified advisory boards develops comprehensive and quality standards for the practice of a type of specialty. The developed standards address high quality requirements for the practice of a certain specialty. The defined standards outline educational and/or practice requirements, any required prerequisites, and the need to adhere to a defined code of ethics for the practice specialty. Certification is different than any type of licensing. Certification is one means by which professionals may be publicly recognized as achieving a high level of education, knowledge base and practice skills for a certain healthcare related specialty. Certification also assists employer organizations and clients in their assessment of appropriate qualifications for candidates seeking positions in organizations and/or involved in private practices. It is commonly held that certification through an organization is fast becoming a “gold standard” for specialty practices. Certification testifies and provides a verification of defined educational requirements, adherence to a solid code of ethics, and in many instances prerequisites of practice experience for the practice in a variety of fields.
What Are the Criteria/standards I Will Need to Meet to Achieve Certification?
Answer: The educational criteria and standards are well and clearly defined within our website. Please access our main page to preview these requirements. Access here.
May I Apply for and Be Conferred Certification if I Have Been Practicing in the Area of Managed Health Care in a Management Role or in a Private Consulting Practice With Out The Need to Meet the Educational Requirements?
Answer: No. The Board that oversees the development and approval of defined criteria and standards for certification will not consider any practice experience as meeting requirements in full. This decision was made as those who are already in a health care practices have varied and different experiences related to this specialty and there is no insured uniformity that all who have practiced this specialty have the same knowledge base and skills attainment. The evaluation of one’s past practice experiences in health care practices is highly variable and subjective. As such, the Board has developed objective criteria/standards for the conferral of certification. For these reasons, practice experience without the attainment of education will not be considered as fulfilling criteria and standards for our certification. AIHCP Education program: access link.
Over the Years, I Have Completed Many Seminars and Continuing Education Courses Related to Managed Health Care. Will These Apply Toward the Education Requirements for Certification?
Answer: Please send in any transcript for review to determine if they can be utilized and an AIHCP course waived. You can contact us here.
What is the Major Practice Focus of a Certified Managed Health Care Consultant?
Answer: a certified Managed Health Care Consultant, as defined by the American Institute of Health Care Professionals, Inc, is a licensed or certified health care professional who has achieved a high level of education, knowledge and skills in the following areas;
Managed Health Care, Health Care Insurance/Reimbursement Systems, Case/Care Management, Health Care Finance, Quality Care Initiatives
A Certified Managed Health Care Consultant is an essential health care professional when it comes to driving the quality, efficiency, and financial performance of health care organizations. They are responsible for advising hospitals and physician groups, insurance companies, and other health care providers on how to negotiate the complex managed care system. Their primary objective is to ensure that the organizational stakeholders continue to provide high-quality patient care while adhering to regulations and saving costs. This consultant is responsible for analyzing and optimizing managed care contracts. These individual reviews the health care providers’ and insurance companies’ agreements and ensure that they are reimbursing fairly and are aligned with appropriate standards and the organization’s goals. By doing so, the consultant bridges the leeway between saving costs and patient welfare.
Certified Managed Health Care Consultants are also in charge of compliance and regulations. They must stay up-to-date on new health care laws, accreditation’s tenant requirements, and payers’ policies. The consultant prepares the organization for these changes, ensuring that the organization is compliant to avoid heavy penalties and other repercussions. In addition, the Managed Health Care Consultant may help develop and implement managed care programs. In these cases, they may help an organization transition from cost-based care to value-based care, implement a measurement system, and adopt new record technologies to improve data collection and organization. Finally, the consultant sits down with the data and organization committee to learn the trends, and report the information so that the relevant people, for example, the biller can act. Another vital role of the consultant is communication. The consultant may work with clinical staff and data which involves strategizing, identifying weak points and solving problems. With their knowledge and skills, they may also be retained by managed care organizations as employees.
Where Do Certified Managed Health Care Consultants Practice?
Answer: Certified Managed Health Care Consultants may be retained as contractors or employees in any health care organization that has managed care contracts with insurance companies, HMO, PPO, physician networks or groups, etc. They may also be contracted or be employed by managed care companies.
What is the Process for Achieving This Certification?
Answer: There is a two-phase process. In order to provide clear and sufficient information on the process we have developed a separate page that defines the process. You may access this information on the certification process at this link: click here.
How Can I Submit an Application?
Answer: Making application is easy. We provide an online application form and a printable application form as well. Those wishing to make application can find these forms at this link. Please note that incomplete applications will not be reviewed. All applications that are submitted must include all required documents and verification as specified for review and consideration of certification conferral. Before making any application, you must meet the defined pre-requisites for a given program and have successfully completed the full continuing education curriculum, or a curriculum from a program that AIHCP, Inc. has officially approved.
After Certification is There a Recertification Process?
Answer: Yes. The American Institute of Health Care Professionals provides a full program for recertification. Detailed information on the criteria to be recertified, after the four-year initial certification period, is provided on our website. Access here.
I Am Currently Certified by the American Institute of Health Care Professionals in Managed Health Care. I Know I Am Required to Achieve Additional Education in Order to Qualify for Recertification in the Future. Do You Offer Any Continuing Education Courses That I May Take to Meet My Recertification Requirements?
Answer: Yes, we offer recertification CE courses. You can view them all by category at the following link. Access here.
Do You Have Any Testimonials From Professionals Who Have Become Certified Through Your Programs?
Answer: Yes. We have a testimonials page on our website that you may view at the following link. Access Here.