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Who should take the AHM-530 exam
- Case administrators and medical directors who inquire a broader administrative background
- Employees who work for health care providers or health insurance plans and want to get the educational background to proceed with a management position in the industry
- Teachers at the school level who teach health care administration
- Agents and brokers who expert in life and health insurance
- Financial executives working with clients looking to maximize their health dollars
- Medical management employees working in hospitals, health systems, and, health insurance plans
Reference: https://www.ahip.org/courses/network-management-ahm530
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AHIP AHM-530 Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Scope and Organization of Network Management | 20% | - Network strategy alignment with organizational goals - Role and function within health plans |
| Topic 2: Government Program Network Requirements | 12% | - Medicare network adequacy rules - Medicaid and workers’ compensation network standards |
| Topic 3: Specialist and Facility Network Management | 15% | - Specialist network design and contracting - Hospital, ancillary, and facility network management |
| Topic 4: Provider Contracts and Compensation | 25% | - Contract terms, obligations, and legal requirements - Reimbursement models: FFS, capitation, bundled payments |
| Topic 5: Provider Selection and Credentialing | 20% | - Selection criteria and processes - Credentialing and recredentialing standards |
| Topic 6: Network Adequacy and Performance Monitoring | 8% | - Access, quality, and capacity metrics - Ongoing network evaluation and maintenance |
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