Certified Healthcare Insurance Professional (CHIP)

This professional certification is designed to equip healthcare professionals with in-depth knowledge and operational skills in health insurance systems, medical claims management, policy interpretation, and regulatory compliance. Through real-world examples and case studies, participants will gain the competencies required to manage insurance processes within healthcare organizations, ensuring financial sustainability, ethical billing, and optimal reimbursement.

• Healthcare administrators and coordinators
• Insurance and billing department professionals
• Revenue cycle managers
• Claims reviewers and processors
• Healthcare quality and risk management professionals
• Pharmacists, physicians, and nurses involved in insurance documentation
• Professionals aiming to specialize in healthcare insurance operations

By the end of this certification, participants will be able to:

• Understand the fundamentals of healthcare insurance systems (local and international).
• Manage insurance claims processes and minimize rejections.
• Interpret and apply insurance policies and coverage guidelines.
• Collaborate with healthcare providers and insurance payers effectively.
• Ensure compliance with regulatory bodies and ethical billing standards.
• Analyze and improve insurance revenue cycle performance.
• Utilize tools and strategies to reduce claim denials and optimize reimbursement.

• Types of health insurance (public, private, social, hybrid)
• Insurance terminology and key concepts
• Stakeholders in the insurance cycle

• Required documents for claim approval
• Linking documentation to medical necessity
• Pre-authorization and approval workflows

• Claims lifecycle and processing stages
• Common errors and reasons for claim denials
• Payment models (fee-for-service, capitation, DRGs)

• Local and international insurance laws
• Role of regulatory bodies (e.g., CCHI, CMS, NHIC, GOSI)
• Fraud, abuse, and audit readiness

• Balancing insurance policies with patient satisfaction
• Handling insurance-related complaints
• Ethical considerations in coverage decisions

• Performance indicators in insurance operations
• Data analysis for claim efficiency
• Strategies for maximizing reimbursement rates

• Knowledge Quizzes: Per module assessments
• Case Studies: Real-world insurance issues and decision-making
• Final Exam: Multiple-choice exam to assess knowledge and application
• Practical Assignment: Review and optimize a claims process or develop an insurance performance dashboard

Participants who complete all course components and pass the final exam will receive: Certified Healthcare Insurance Professional (CHIP) Certificate from the American Institute of Medical Sciences and Management (AIMSM).

Total Duration: 20 Hours

• 14 Hours: Live Lectures & Interactive Discussions
• 6 Hours: Assignments & Case-Based Applications

• In-Person: Classroom workshops and insurance labs
• Online: Virtual live sessions + e-learning modules
• Blended: Mix of face-to-face and online content